Canadian Health Survey on Children and Youth

Getting started

Why are we conducting this survey?

Statistics Canada is conducting a survey about the health and well-being of Canadian children and youth and you have been selected for this survey. The Canadian Health Survey on Children and Youth explores issues that have an impact on the physical and mental health of children and youth aged 1 to 17 years old such as use and availability of health care services, health conditions, mental health and substance use.

This survey also gives young people and their parents or guardians the opportunity to share their experiences, in complete confidentiality, to reflect a true picture of what affects youth's health and well-being today. The data will be used to develop programs and policies to better serve Canadian youth.

The questionnaire for parents or guardians of children of all ages contains two sections: a short preliminary section and the health section.

In addition, youth between the ages of 12 and 17 years old as of [August 31, 2026] have their own health questionnaire to complete.

Your information may also be used by Statistics Canada for other statistical and research purposes.

Although voluntary, your participation is important so that the information collected is as accurate and complete as possible.

Other important information

Authorization and confidentiality

Your data is collected under the authority of the Statistics Act. The information you provide will be kept strictly confidential. If you give your opinion about another person, that person has the right to ask us for any information we have about them. However, we have the right not to tell them what you have told us, if we think that sharing this information might not be safe for you. If there is any doubt at all, we will not share your information.

Record linkages

To enhance the data from this survey and to reduce the response burden, Statistics Canada will combine the information you provide with information from the tax data of all members of your household. Your provincial or territorial ministry of health or the Institut de la statistique du Québec for Quebec respondents may also combine the information you provide with other surveys or administrative sources.

Statistics Canada may also combine the information you provide with other survey or administrative data sources.
Contact us if you have any questions or concerns about record linkage:

Email: infostats@statcan.gc.ca

Telephone: 1-877-949-9492

Mail:
Chief Statistician of Canada
Statistics Canada
Attention of Director, Centre for Population Health Data
150 Tunney's Pasture Driveway
Ottawa, Ontario K1A 0T6

Respondent Verification

Is there a child in this household born in [birth year]?

What is this child's first and last name?

If more than one child was born in [birth year], please report for the [young/old]est child born during the year.

First name
Last name

May I speak with [First name of selected child] [Last name of selected child]'s parent or legal guardian?

Yes, parent or legal guardian available
No, parent or legal guardian not available at this time
No, parent or legal guardian not available to complete this survey

This survey should be completed by the parent, guardian or person who is the most knowledgeable about [First name of selected child]'s health and day-to-day activities.

Are you the parent or guardian of [First name of selected child] [Last name of selected child]?

What is [First name of selected child]'s date of birth?

Day
Month
Year (prefilled with [BIRTHYEAR])

In which province or territory do you currently live?

Province or territory
- Alberta
- British Columbia
- Manitoba
- New Brunswick
- Newfoundland and Labrador
- Northwest Territories
- Nova Scotia
- Nunavut
- Ontario
- Prince Edward Island
- Quebec
- Saskatchewan
- Yukon

Parent or legal guardian consent

For youth 12 to 17 years old, the Canadian Health Survey on Children and Youth consists of two questionnaires: one questionnaire to be completed by you and another to be completed by your child. Please note that your child's questionnaire is just as important as yours, as it includes different questions.

Since [First name of selected child] was less than 15 years old when [First name of selected child] was selected to participate in this survey, your permission is needed before contacting [First name of selected child] to complete the youth questionnaire.

Do we have your permission to contact [First name of selected child] to complete the other portion of the Canadian Health Survey on Children and Youth?

Yes
No
- To help us improve our survey, please specify why you do not grant permission to contact [First name of selected child] to complete the other portion of the Canadian Health Survey on Children and Youth

Confirm the date that consent was provided by clicking the Next button.

Date

An invitation to participate in the Canadian Health Survey on Children and Youth will be sent to your child. What email address and telephone number could we use to contact [First name of selected child]?

If your child cannot be contacted at an email address and/or phone number of their own, you may provide your own email address and/or phone number and pass on the invitation to your child.

Email address to contact [First name of selected child]
Please confirm the email address to contact [First name of selected child]
Telephone number to contact [First name of selected child]

Household composition

List all persons that usually live at this address, including yourself.
[First name of selected child] has already been listed.

Include all persons who have their main residence at this address, even if they are temporarily away, such as joint custody, students, persons staying at a secondary residence or cottage.

People usually living or staying at this address.

First name
Last name
Age

Enter the information for the first person to add and then press the Add this person button. Repeat for each person who lives at this address.

Once every member of the household has been added, press the Next button to continue.

What is the relationship of the following people to [FNAME]?

Please note that the dropdown list of possible responses is the same for everyone. Some relationship options may not be applicable to all members of your household.

Relationship to [FNAME]

> [HHC_Q001A] [HHC_Q001B], age [HHC_Q001D]

Birth parent
Step parent
Adoptive parent
Foster parent
Full brother or sister
Half brother or sister
Stepbrother or sister
Adopted brother or sister
Foster brother or sister
Grandparent
Boyfriend or girlfriend
Common-law partner or spouse
Son or daughter
Other related
Unrelated

Who is the parent, guardian or person completing this survey about [FNAME]?

This survey should be completed by the parent, guardian or person who is the most knowledgeable about [FNAME]'s health and day-to-day activities.

[HHC_Q001A] [HHC_Q001B], age [HHC_Q001]

What is the relationship of the following people to you?

Relationship to you

> [HHC_Q001A] [HHC_Q001B], age [HHC_Q001D]

Your husband or wife
Your common-law partner
Your father or mother
Your son or daughter (birth, adopted or step)
Your brother or sister
Your foster father or mother
Your foster son or daughter
Your grandfather or grandmother
Your grandson or granddaughter
Your in-law
Other related
Unrelated

Does [FNAME] have any brothers or sisters not already listed and living elsewhere?

Include step, half and adopted brothers and sisters.

Yes
How many?
- 1
- 2
- 3
- 4
- 5 or more
No

Contact information

Statistics Canada may contact you in the future to follow-up on this survey.

What is your telephone number?

Telephone number

What email address could we use to contact your household, if applicable?

Email address

Please confirm your email address.

Email address

Please verify your mailing address and correct it if it is not accurate.

Street address, including apartment or unit number (if applicable)
City, municipality, town, village, Indian reserve
Province or territory
- Alberta
- British Columbia
- Manitoba
- New Brunswick
- Newfoundland and Labrador
- Northwest Territories
- Nova Scotia
- Nunavut
- Ontario
- Prince Edward Island
- Quebec
- Saskatchewan
- Yukon
Postal code

Gender and sex at birth – pmk

The following questions are about gender and sex at birth.

What is [FNAME]'s gender?

Gender refers to an individual's personal and social identity as a [man, a woman or a person who is not exclusively a man or a woman/boy, a girl or a person who is not exclusively a boy or a girl], for example, non-binary, agender, gender fluid, queer or Two-Spirit.

Is it:

[Man/Boy]
[Woman/Girl]
Or please specify
- Specify [FNAME]'s gender

What was [FNAME]'s sex at birth?

Sex at birth refers to the sex recorded on a person's first birth certificate. It is typically observed based on a person's reproductive system and other physical characteristics.

Male
Female

What is your gender?

Gender refers to an individual's personal and social identity as a man, a woman or a person who is not exclusively a man or a woman, for example, non-binary, agender, gender fluid, queer or Two-Spirit.

Is it:

Man
Woman
Or please specify
- Specify your gender

What was your sex at birth?

Sex at birth refers to the sex recorded on a person's first birth certificate. It is typically observed based on a person's reproductive system and other physical characteristics.

Male
Female

What is [First name of PMK spouse/your spouse or partner]'s gender?

Is it:

Man
Woman
Or please specify
- Specify [First name of PMK spouse/your spouse or partner]'s gender

What was [First name of PMK spouse/your spouse or partner]'s sex at birth?

Sex at birth refers to the sex recorded on a person's first birth certificate. It is typically observed based on a person's reproductive system and other physical characteristics.

Male
Female

Please verify that all of the information is correct.

If all the information is correct, then press the Next button.
To make changes, please press the Previous button.

> [FNAME]'s information
Gender: [Man/Boy/Man (or boy)/Woman/Girl/Woman (or girl)/[RRS4_S030]/Information not provided]
Sex at birth: [Male/Female/Information not provided]

> Your information
Gender: [Man/Woman/[RRS4_S050]/Information not provided]
Sex at birth: [Male/Female/Information not provided]

> [First name of PMK spouse/Your spouse or partner]'s information
Gender: [Man/Woman/[RRS4_S070]/Information not provided]
Sex at birth: [Male/Female/Information not provided]

[For reasons of text length and without discrimination, the masculine pronouns are used throughout the questionnaire for respondents whose gender was reported using the write-in option.]

Youth respondent verification

Are you [First name of selected child] [Last name of selected child]?

What is your date of birth?

Day
Month
Year

In which province or territory do you currently live?

Province or territory
- Alberta
- British Columbia
- Manitoba
- New Brunswick
- Newfoundland and Labrador
- Northwest Territories
- Nova Scotia
- Nunavut
- Ontario
- Prince Edward Island
- Quebec
- Saskatchewan
- Yukon

Gender and sex at birth - youth

The following questions are about gender and sex at birth.

What is your gender?

Is it:

[Man/Boy]
[Woman/Girl]
Or please specify
- Specify your gender

What was your sex at birth?

Sex at birth refers to the sex recorded on a person's first birth certificate. It is typically observed based on a person's reproductive system and other physical characteristics.

Male
Female

Please verify that all of the information is correct.

Gender: [Man/Boy/Man (or boy)/Woman/Girl/Woman (or girl)/[SBG_S010]/Information not provided]
Sex at birth: [Male/Female/Information not provided]

[For reasons of text length and without discrimination, the masculine pronouns are used throughout the questionnaire for respondents whose gender was reported using the write-in option./" "]

Marital status

What is your marital status?

Is it:

Married
For Quebec residents only, select the "Married" category if your marital status is "civil union".
Living common law
Two people who live together as a couple but who are not legally married to each other.
Never married (not living common law)
Separated (not living common law)
Divorced (not living common law)
Widowed (not living common law)

General health

The following questions are about health. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.

In general, how is [FNAME]'s health?

Would you say:

Excellent
Very good
Good
Fair
Poor

In general, how is your health?

Would you say:

Excellent
Very good
Good
Fair
Poor

In general, how is [FNAME]'s mental health?

Would you say:

Excellent
Very good
Good
Fair
Poor

In general, how is your mental health?

Would you say:

Excellent
Very good
Good
Fair
Poor

Using a scale of 0 to 10, where 0 means "very dissatisfied" and 10 means "very satisfied", how do you feel about your life as a whole right now?

0 - Very dissatisfied
1
2
3
4
5
6
7
8
9
10 - Very satisfied

Thinking about the amount of stress in your life, how would you describe most of your days?

Would you say:

Not at all stressful
Not very stressful
A bit stressful
Quite a bit stressful
Extremely stressful

The following questions are about health. By health, we mean not only the absence of disease or injury but also physical, mental and social well-being.

In general, how is your health?

Would you say:

Excellent
Very good
Good
Fair
Poor

In general, how is your mental health?

Would you say:

Excellent
Very good
Good
Fair
Poor

Using a scale of 0 to 10, where 0 means "very dissatisfied" and 10 means "very satisfied", how do you feel about your life as a whole right now?

0 - Very dissatisfied
1
2
3
4
5
6
7
8
9
10 - Very satisfied

Thinking about the amount of stress in your life, how would you describe most of your days?

Would you say:

Not at all stressful
Not very stressful
A bit stressful
Quite a bit stressful
Extremely stressful

How would you usually describe yourself?

Would you say:

Happy and interested in life
Somewhat happy
Somewhat unhappy
Unhappy with little interest in life
So unhappy that life is not worthwhile

Height and weight

How tall [is [FNAME]/are you] without shoes on?

Feet
Inches
OR
Centimetres

How much [does [FNAME]/do you] weigh without shoes on?

Weight
Pounds or kilograms
- Pounds
- Kilograms

Long-term health conditions

The following questions are about certain long-term health conditions which [FNAME] may have. We are interested in long-term conditions which are expected to last, or have already lasted 6 months or more and that have been diagnosed by a health professional.

Has [FNAME] been diagnosed with any of the following long-term health conditions?

Select all that apply.

Asthma
Diabetes
Include type 1 or type 2 diabetes.
Exclude prediabetes.
Allergies diagnosed as a result of allergy test
Epilepsy
Exclude a one-time, non-recurring seizure.
An anxiety disorder, such as a phobia, a panic disorder or generalized anxiety disorder
A mood disorder such as depression, bipolar disorder, mania or dysthymia
An eating disorder such as anorexia nervosa, bulimia or binge eating disorder
A learning disability or learning disorder
Learning disabilities or learning disorders are difficulties in the ability to learn or use specific academic skills e.g., reading, writing or arithmetic.
Attention deficit disorder or attention deficit hyperactivity disorder, also known as ADD or ADHD
Autism spectrum disorder, also known as autism, autistic disorder, Asperger's disorder or pervasive developmental disorder
Fetal Alcohol Spectrum Disorder, also known as FASD
Post-traumatic stress disorder, also known as PTSD
Chronic pain
Obsessive-compulsive disorder, also known as OCD
Oppositional defiant disorder, also known as ODD
Substance use disorder such as alcohol use disorder, cannabis dependence, or opioid dependence
Any other long-term physical, mental, developmental or intellectual conditions that are expected to last or have already lasted 6 months or more and that have been diagnosed by a health professional
- Specify other condition 1
- Specify other condition 2
- Specify other condition 3
- Specify other condition 4
- Specify other condition 5
OR
None of the above

How often do the following conditions limit [his/her] daily activities?

Asthma
- Never
- Rarely
- Sometimes
- Often
- Always
Diabetes
- Never
- Rarely
- Sometimes
- Often
- Always
Allergies diagnosed as a result of allergy test
- Never
- Rarely
- Sometimes
- Often
- Always
Epilepsy
- Never
- Rarely
- Sometimes
- Often
- Always
An anxiety disorder, such as a phobia, a panic disorder or generalized anxiety disorder
- Never
- Rarely
- Sometimes
- Often
- Always
A mood disorder such as depression, bipolar disorder, mania or dysthymia
- Never
- Rarely
- Sometimes
- Often
- Always
An eating disorder such as anorexia nervosa, bulimia or binge eating disorder
- Never
- Rarely
- Sometimes
- Often
- Always
A learning disability or learning disorder
- Never
- Rarely
- Sometimes
- Often
- Always
Attention deficit disorder or attention deficit hyperactivity disorder, also known as ADD or ADHD
- Never
- Rarely
- Sometimes
- Often
- Always
Autism spectrum disorder, also known as autism, autistic disorder, Asperger's disorder or pervasive developmental disorder
- Never
- Rarely
- Sometimes
- Often
- Always
Fetal Alcohol Spectrum Disorder, also known as FASD
- Never
- Rarely
- Sometimes
- Often
- Always
Post-traumatic stress disorder, also known as PTSD
- Never
- Rarely
- Sometimes
- Often
- Always
Chronic pain
- Never
- Rarely
- Sometimes
- Often
- Always
Obsessive-compulsive disorder, also known as OCD
- Never
- Rarely
- Sometimes
- Often
- Always
Oppositional defiant disorder, also known as ODD
- Never
- Rarely
- Sometimes
- Often
- Always
Substance use disorder such as alcohol use disorder, cannabis dependence, or opioid dependence
- Never
- Rarely
- Sometimes
- Often
- Always
[LTC_Q006A]
- Never
- Rarely
- Sometimes
- Often
- Always
[LTC_Q006C]
- Never
- Rarely
- Sometimes
- Often
- Always
[LTC_Q006E]
- Never
- Rarely
- Sometimes
- Often
- Always
[LTC_Q006G]
- Never
- Rarely
- Sometimes
- Often
- Always
[LTC_Q006I]
- Never
- Rarely
- Sometimes
- Often
- Always
Other long-term condition
- Never
- Rarely
- Sometimes
- Often
- Always

How old was [FNAME] when [he/she] was first diagnosed with the following conditions?

Asthma
- Age in years
Diabetes
- Age in years
Allergies diagnosed as a result of allergy test
- Age in years
Epilepsy
- Age in years
An anxiety disorder, such as a phobia, a panic disorder or generalized anxiety disorder
- Age in years
A mood disorder such as depression, bipolar disorder, mania or dysthymia
- Age in years
An eating disorder such as anorexia nervosa, bulimia or binge eating disorder
- Age in years
A learning disability or learning disorder
- Age in years
Attention deficit disorder or attention deficit hyperactivity disorder, also known as ADD or ADHD
- Age in years
Fetal Alcohol Spectrum Disorder, also known as FASD
- Age in years
Post-traumatic stress disorder, also known as PTSD
- Age in years
Chronic pain
- Age in years
Obsessive-compulsive disorder, also known as OCD
- Age in years
Oppositional defiant disorder, also known as ODD
- Age in years
Substance use disorder such as alcohol use disorder, cannabis dependence, or opioid dependence
- Age in years
[LTC_Q006A]
- Age in years
[LTC_Q006C]
- Age in years
[LTC_Q006E]
- Age in years
[LTC_Q006G]
- Age in years
[LTC_Q006I]
- Age in years
Other long-term condition
- Age in years

Has [FNAME] had any asthma symptoms or asthma attacks in the past 12 months?

When [FNAME] was first diagnosed with diabetes, how long was it before [he/she] started on insulin?

Less than 1 month
1 month to less than 2 months
2 months to less than 6 months
6 months to less than a year
1 year or more
Never

Does [FNAME] use any of the following medication?

Any medicine for asthma such as inhalers (pumps), nebulizers, pills, liquids or injections in the past 12 months
- Yes
- No
Currently takes insulin for [his/her] diabetes
- Yes
- No
Pills to control [his/her] blood sugar in the past month
- Yes
- No
Medication for an anxiety disorder in the past 12 months
- Yes
- No
Medication for a mood disorder such as depression, bipolar disorder, mania or dysthymia in the past 12 months
- Yes
- No
Medication for ADD or ADHD In the past 12 months
- Yes
- No

The following questions are about the time prior to [FNAME]'s autism spectrum disorder diagnosis.

What were the initial concerns about [FNAME]'s health or development?

Select all that apply.

Would you say:

Language or communication
e.g., speech delay, difficulty having a back-and-forth conversation
Social interaction
e.g., difficulty playing with others, making friends
Sensory
e.g., sensitivity to sounds, textures, light
Emotions or behaviour
e.g., emotional outbursts, difficulty coping with change
Motor skills
e.g., difficulty manipulating objects, picking up small objects, holding a pen, coordination issues
Learning or concentration
e.g., difficulty learning a new task
Sleep
e.g., difficulty falling and staying asleep
Eating habits
e.g., avoidance of certain types of food
Self-care
e.g., difficulty dressing
Other

How old was [FNAME] when these initial concerns were first observed?

Years
Months

Who observed these initial concerns?

Select all that apply.

Would you say:

Parent, guardian or family member
Physician
e.g., family doctor, general practitioner, pediatrician
Other health care professional
e.g., nurse, social worker, speech-language therapist or pathologist
Child care provider, teacher or school staff
Friend, neighbour or community member
Other

Now we'd like to ask about [FNAME]'s autism spectrum disorder diagnosis.

Which one of the following professionals diagnosed [FNAME]'s autism spectrum disorder?

Would you say:

Family doctor or general practitioner
Developmental pediatrician
Psychiatrist or child psychiatrist
Psychologist or child psychologist
General pediatrician
Neurologist
Nurse Practitioner
Other

How old was [FNAME] when [he/she] was first diagnosed with autism spectrum disorder?

Indicate [FNAME's] age in years and months, e.g., 4 years and 6 months.

Years
Months

Did you experience any of the following challenges in obtaining an autism spectrum disorder diagnosis for [FNAME]?

Select all that apply.

Would you say:

Initial concerns did not seem related to autism
Did not have a regular health care provider
Did not know who or where to seek professional help
Concerns about stigma associated with an autism diagnosis
e.g., being treated differently or discriminated against
Health professionals were hesitant to make a referral for a diagnostic assessment
Child was not initially diagnosed with autism despite having a diagnostic assessment
Long waitlist
Cost
Distance to professional help
Difficulty accessing health professionals during the COVID-19 pandemic
Other
OR
No challenges experienced

Preterm birth status

Was [FNAME] born pre-term?

Preterm births are live births with a gestational age less than 37 weeks.

Yes
What was the gestational age of [FNAME] at birth?
Was it:
- Less than 28 weeks
- 28 to less than 32 weeks
- 32 to less than 37 weeks
No
Don't know

Child functioning

Now some questions about difficulties your child may have.

Does [FNAME] wear glasses[ or contact lenses]?

When wearing [his/her] glasses[ or contact lenses], does [FNAME] have difficulty seeing?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Does [FNAME] have difficulty seeing?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Does [FNAME] use a hearing aid?

When using [his/her] hearing aid, does [FNAME] have difficulty hearing sounds like people's voices or music?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Does [FNAME] have difficulty hearing sounds like people's voices or music?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Does [FNAME] use any equipment or receive assistance for walking?

Without [his/her] equipment or assistance, does [FNAME] have difficulty walking?

Would you say [FNAME] has:

Some difficulty
A lot of difficulty
Cannot do at all

With [his/her] equipment or assistance, does [FNAME] have difficulty walking?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Compared with children of the same age, does [FNAME] have difficulty walking?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Compared with children of the same age, does [FNAME] have difficulty picking up small objects with [his/her] hand?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Does [FNAME] have difficulty understanding you?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

When [FNAME] speaks, do you have difficulty understanding [him/her]?

Would you say you have:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Without [his/her] equipment or assistance, does [FNAME] have difficulty walking 100 yards/metres on level ground? That would be about the length of 1 football field.

Would you say [FNAME] has:

Some difficulty
A lot of difficulty
Cannot do at all

Without [his/her] equipment or assistance, does [FNAME] have difficulty walking 500 yards/metres on level ground? That would be about the length of 5 football fields.

Would you say [FNAME] has:

Some difficulty
A lot of difficulty
Cannot do at all

With [his/her] equipment or assistance, does [FNAME] have difficulty walking 100 yards/metres on level ground? That would be about the length of 1 football field.

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

With [his/her] equipment or assistance, does [FNAME] have difficulty walking 500 yards/metres on level ground? That would be about the length of 5 football fields.

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Compared with children of the same age, does [FNAME] have difficulty walking 100 yards/metres on level ground? That would be about the length of 1 football field.

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Compared with children of the same age, does [FNAME] have difficulty walking 500 yards/metres on level ground? That would be about the length of 5 football fields.

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Does [FNAME] have difficulty with self-care such as feeding or dressing [himself/herself]?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

When [FNAME] speaks, does [he/she] have difficulty being understood by people inside of this household?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

When [FNAME] speaks, does [he/she] have difficulty being understood by people outside of this household?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Compared with children of the same age, does [FNAME] have difficulty learning things?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Compared with children of the same age, does [FNAME] have difficulty playing?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Compared with children of the same age, how much does [FNAME] kick, bite, or hit other children or adults?

Would you say:

Not at all
The same or less
More
A lot more

Compared with children of the same age, does [FNAME] have difficulty remembering things?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Does [FNAME] have difficulty concentrating on an activity that [he/she] enjoys doing?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Does [FNAME] have difficulty accepting changes in [his/her] routine?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Compared with children of the same age, does [FNAME] have difficulty controlling [his/her] behaviour?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

Does [FNAME] have difficulty making friends?

Would you say [FNAME] has:

No difficulty
Some difficulty
A lot of difficulty
Cannot do at all

How often does [FNAME] seem very anxious, nervous or worried?

Would you say:

Daily
Weekly
Monthly
A few times a year
Never

How often does [FNAME] seem very sad or depressed?

Would you say:

Daily
Weekly
Monthly
A few times a year
Never

Emotional behavioural scale

Below is a list of statements that describes some of the feelings and behaviours of children and youth. For each statement, please select the response that best describes [you/[FNAME]] now or within the past 6 months. You may only select one response.

[A/I am a]ngry and resentful
- Never or not true
- Sometimes or somewhat true
- Often or very true
[A/I am a]nxious or on edge
- Never or not true
- Sometimes or somewhat true
- Often or very true
[A/I a]rgue[/s] a lot with adults
- Never or not true
- Sometimes or somewhat true
- Often or very true
[B/I b]lame[/s] others for [his/her/my] own mistakes
- Never or not true
- Sometimes or somewhat true
- Often or very true
[Can't concentrate, can't pay attention for long/I have trouble concentrating or paying attention]
- Never or not true
- Sometimes or somewhat true
- Often or very true
[C/I c]an't stay seated when required to do so
- Never or not true
- Sometimes or somewhat true
- Often or very true
[Distractible, has trouble sticking to any activity/I am easily distracted, have difficulty sticking to any activity]
- Never or not true
- Sometimes or somewhat true
- Often or very true
[Easily/I am easily] annoyed by others
- Never or not true
- Sometimes or somewhat true
- Often or very true
[F/I f]ail[/s] to finish things [[he/she]/I] start[/s]
- Never or not true
- Sometimes or somewhat true
- Often or very true
[F/I f]eel[/s] worthless or inferior
- Never or not true
- Sometimes or somewhat true
- Often or very true
[F/I f]idget[/s]
- Never or not true
- Sometimes or somewhat true
- Often or very true
[F/I f]ind[/s] it hard to stop worrying
- Never or not true
- Sometimes or somewhat true
- Often or very true
[Has/I have] difficulty awaiting turn in games or groups
- Never or not true
- Sometimes or somewhat true
- Often or very true
[Has/I have] trouble enjoying [[him/her]/my]self
- Never or not true
- Sometimes or somewhat true
- Often or very true
[Impulsive or acts without thinking/I act without thinking or stopping to think]
- Never or not true
- Sometimes or somewhat true
- Often or very true
[Loses your/I lose my] temper
- Never or not true
- Sometimes or somewhat true
- Often or very true
[Nervous, high-strung or tense/I am nervous or tense]
- Never or not true
- Sometimes or somewhat true
- Often or very true
[Talks about killing self/I think about killing myself]
- Never or not true
- Sometimes or somewhat true
- Often or very true
[T/I am t]oo fearful or anxious
- Never or not true
- Sometimes or somewhat true
- Often or very true
[U/I am u]nhappy, sad or depressed
- Never or not true
- Sometimes or somewhat true
- Often or very true

Pediatric symptom checklist

For the following questions, please think about [FNAME]'s overall behaviour in general.

These questions are about your child's behavior. Think about what you would expect of other children the same age and tell us how much each statement applies to your child.

Does your child seem nervous or afraid?
- Not at all
- Somewhat
- Very much
Does your child seem sad or unhappy?
- Not at all
- Somewhat
- Very much
Does your child get upset if things are not done in a certain way?
- Not at all
- Somewhat
- Very much
Does your child have a hard time with change?
- Not at all
- Somewhat
- Very much
Does your child have trouble playing with other children?
- Not at all
- Somewhat
- Very much
Does your child break things on purpose?
- Not at all
- Somewhat
- Very much
Does your child fight with other children?
- Not at all
- Somewhat
- Very much
Does your child have trouble paying attention?
- Not at all
- Somewhat
- Very much
Does your child have a hard time calming down?
- Not at all
- Somewhat
- Very much
Does your child have trouble staying with one activity?
- Not at all
- Somewhat
- Very much
Is your child aggressive?
- Not at all
- Somewhat
- Very much
Is your child fidgety or unable to sit still?
- Not at all
- Somewhat
- Very much
Is your child angry?
- Not at all
- Somewhat
- Very much
Is it hard to take your child out in public?
- Not at all
- Somewhat
- Very much
Is it hard to comfort your child?
- Not at all
- Somewhat
- Very much
Is it hard to know what your child needs?
- Not at all
- Somewhat
- Very much
Is it hard to keep your child on a schedule or routine?
- Not at all
- Somewhat
- Very much
Is it hard to get your child to obey you?
- Not at all
- Somewhat
- Very much

Regular health care provider

Now, here are some questions about primary health care. This type of health care is often delivered by family doctors, pediatricians or nurse practitioners.

Does [FNAME] have a regular health care provider?

By this, we mean a primary health care professional that you or [FNAME] can consult with when [FNAME] needs care or advice for [his/her] health.

Select "Yes, another health professional" if [he/she] receive[s] regular care from locums.

Yes, a family doctor or pediatrician
Yes, a nurse practitioner
Yes, another health professional
- Specify the other health professional
No

When [FNAME] consults with [this family doctor or paediatrician/this nurse practitioner/this other health professional], do you have to pay out-of-pocket for the consultation because they work in a private pay model?

Exclude any fees associated with medical notes for work or school, expedited blood work, prescription renewals, cosmetic procedures, travel medicine advice and vaccines, tests requested by employers or insurance companies, and other services that are not covered by the universal health care system.

Yes
No
Don't know

Some patients receive primary health care from a team of health professionals working together to provide coordinated services and care. In addition to family doctors and nurses, these teams could include social workers, dieticians and pharmacists, but do not include medical specialists (e.g., cardiologists, oncologists).

Is [FNAME] a patient of a team of health professionals that work together to provide [him/her] with coordinated services or care?

Exclude care provided by teams of medical specialists (e.g., cardiologists, oncologists).

Depending on where you live, these teams might be called a Family Health Team, Family Medicine Group, Integrated Care Network or Primary Care Network.

Yes
No
Don't know

Do you have to pay out-of-pocket for any of the services provided by the team of health professionals?

Yes
No
Don't know

Why does [FNAME] not have a regular health care provider?

Select all that apply.

Would you say:

Currently on a waitlist
Does not need one in particular
No one in the area is taking new patients
There are no health care providers in the area
Have not tried to find one
[FNAME] had one who left, retired, or changed their practice
[FNAME] moved to a new area
Other
- Specify the other reason [he/she] does not have a regular health care provider

The following questions are about consultations [FNAME] may have had in the past 12 months with a primary health care provider when [he/she] was sick or you were concerned about [his/her] health.

In the past 12 months, did [FNAME] consult a primary health care provider when [he/she] was sick or you were concerned about [his/her] health?

Exclude visits to the emergency department, scheduled check-ups or routine testing, and consultations with optometrists, dentists, or medical specialists (e.g., cardiologists, oncologists).

Include both in-person and virtual consultations, such as over the telephone, by video, or by written correspondence.

Thinking about the most recent consultation when [FNAME] was sick or you were concerned about [his/her] health, was this consultation with [his/her] [family doctor or pediatrician/nurse practitioner/other health professional who is [his/her] regular health care provider]?

Exclude consultations with medical specialists (e.g., cardiologists, oncologists).

Include both in-person and virtual consultations, such as over the telephone, by video, or by written correspondence.

Thinking about the most recent consultation when [FNAME] was sick or you were concerned about [his/her] health, was this consultation with a member of the team of health professionals who provides [FNAME] with coordinated services or care?

Exclude consultations with medical specialists (e.g., cardiologists, oncologists).

Include both in-person and virtual consultations, such as over the telephone, by video, or by written correspondence.

Thinking about the most recent consultation when [FNAME] was sick or you were concerned about [his/her] health, did you have to pay out-of-pocket because this primary health care provider works in a private pay model?

Yes
No
Don't know

Still thinking about this most recent consultation, how long did you have to wait between the time you requested care and when [FNAME] consulted [this primary health care provider/[his/her] family doctor/[his/her] nurse practitioner/[his/her] other health professional who is [his/her] regular health care provider/a member from [his/her] team of health professionals]?

Would you say:

The same day
The next day
2 to 3 days
4 to 6 days
1 week to less than 2 weeks
2 weeks to less than 1 month
1 month to less than 3 months
3 months to less than 6 months
6 months or more

Still thinking about this most recent consultation, how satisfied were you with the time you had to wait between requesting care and when [FNAME] consulted with [this primary health care provider/[his/her] family doctor/[his/her] nurse practitioner/[his/her] other health professional who is [his/her] regular health care provider/a member from [his/her] team of health professionals]?

Woud you say:

Very satisfied
Satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied

Still thinking about this most recent consultation, indicate to what extent you agree or disagree with the following statement.

[FNAME] received health care that was sensitive to [his/her] cultural background and identity from [this primary health care provider/[his/her] family doctor/[his/her] nurse practitioner/[his/her] other health professional who is [his/her] regular health care provider/this member of [his/her] team of health professionals].

This is health care that makes the patient feel they are respected, safe and can trust the health care provider.

Include how [FNAME] was treated based on age, sex, gender, sexual orientation, ethnicity, Indigenous identity, race, language, accent, religion or spirituality, disability, or other factors.

Would you say:

Strongly agree
Agree
Neither agree nor disagree
Disagree
For which reasons do you feel [FNAME] did not receive health care that was sensitive to [his/her] cultural background and identity?
Select all that apply.
- Ethnicity or culture
- Indigenous identity
- Race or skin colour
- Language
- Accent
- Religion or spirituality
- Age
- Sex
  Refers to sex assigned at birth.
- Gender
  Refers to an individual's personal and social identity as a man, woman, or non-binary person.
- Sexual orientation
  Refers to how a person describes their sexuality.
- Disability
- Other reason
  - Specify the other reason you disagree
  OR
- Don't know
Strongly disagree
For which reasons do you feel [FNAME] did not receive health care that was sensitive to [his/her] cultural background and identity?
Select all that apply.
- Ethnicity or culture
- Indigenous identity
- Race or skin colour
- Language
- Accent
- Religion or spirituality
- Age
- Sex
  Refers to sex assigned at birth.
- Gender
  Refers to an individual's personal and social identity as a man, woman, or non-binary person.
- Sexual orientation
  Refers to how a person describes their sexuality.
- Disability
- Other reason
  - Specify the other reason you disagree
  OR
- Don't know

Electronic health information

The following questions are about whether you can access [FNAME]'s health information online through websites, applications or portals.

This information may be provided by health authorities, hospitals, doctors, laboratories, pharmacies or other health professionals.

Which of the following types of information about [FNAME]'s health do you have access to through websites, applications, or portals?

Select a category even if you have access to some, but not all of this type of health information electronically.

e.g., select "Laboratory test results" if you can access some, but not all of [FNAME]'s laboratory test results electronically

Select all that apply.

Would you say:

Laboratory test results
COVID-19 vaccine records
Vaccine or immunization records other than for COVID-19
Current medications and medication history
Include requests for prescription renewals
Patient visit summaries
Specialist consultation notes or records
Upcoming appointments
Forms and questionnaires
Progress notes
Discharge summaries
Medical imaging reports
Other health information
- Specify the other health information you have access to
OR
None of the above

Perceived need for care

The following questions deal with the different kinds of professional help [[FNAME]/you] received, or thought were needed, for [his/her/your] emotions[ or mental health/, mental health or use of alcohol or drugs].

During the past 12 months, did [[FNAME]/you] receive any form of professional help for [his/her/your] emotions[ or mental health/, mental health or use of alcohol or drugs]?

This could include counseling or therapy, help with interpersonal relationships, or prescription medication.

Which type of professional help did [[FNAME]/you] receive?

Select all that apply.

Was it:

Counseling or therapy
Prescription medication
Other
- Specify other professional help

You mentioned that [[FNAME]/you] received professional help for [his/her/your] emotions[ or mental health/, mental health or use of alcohol or drugs]. Do you think [you/he/she] received all the help needed during the past 12 months?

Why do you think [[FNAME]/you] did not receive all the help [you/he/she] needed during the past 12 months?

Select all that apply.

Would you say:

Preferred to self-manage
Didn't know how or where to get help
Too busy
Job interfered
e.g., workload, hours of work or no cooperation from supervisor
Help was not readily available
e.g., long wait lists
Help was not available where you live
Had trouble finding or affording transportation
Help did not meet [his/her/your] needs
Didn't have confidence in health care system or social services
Couldn't afford to pay
Afraid of what others would think
Language or cultural barriers
Other
- Specify other reason

You mentioned that [[FNAME]/you] did not receive professional help for [his/her/your] emotions[ or mental health/, mental health or use of alcohol or drugs]. Do you think [you/he/she] needed this kind of help during the past 12 months?

Why do you think [you/he/she] did not receive the help [you/he/she] needed during the past 12 months?

Select all that apply.

Would you say:

Preferred to self-manage
Didn't know how or where to get help
Too busy
Job interfered
e.g., workload, hours of work or no cooperation from supervisor
Help was not readily available
e.g., long wait lists
Help was not available where you live
Had trouble finding or affording transportation
Help did not meet [his/her/your] needs
Didn't have confidence in health care system or social services
Couldn't afford to pay
Afraid of what others would think
Language or cultural barriers
Other
- Specify other reason

Accessing mental health care

In the past 12 months, did you consult a professional from any of the following places about concerns with your emotions, mental health or use of alcohol or drugs?

Include in-person, telephone and virtual appointments.

Select all that apply.

Family doctor or pediatrician's office
School
Mental health professional's office, such as a psychologist, psychiatrist, social worker or other counselor
Community mental health or addictions agency or clinic
Walk-in clinic
Urgent care clinic or emergency room
Hospital
Phone helpline or crisis hotline (Include chat and text.)
Other
- Specify other location
OR
None of the above

Earlier, you mentioned that in the past 12 months, you [received professional help for your emotions, mental health or use of alcohol or drugs, but did not receive all the help needed/did not receive professional help for your emotions, mental health or use of alcohol or drugs, but you think you needed this kind of help].

Is there a place that you would have preferred to get the help you needed for your emotions, mental health or use of alcohol or drugs?

Include in-person, telephone and virtual appointments.

Places to consider include the following:

Family doctor or pediatrician's office
School
Mental health professional's office, such as a psychologist, psychiatrist, social worker or other counselor
Community mental health or addictions agency or clinic
Walk-in clinic
Urgent care clinic or emergency room
Hospital
Phone helpline or crisis hotline
Other locations where you could have received the help you needed for your emotions, mental health or use of alcohol or drugs.

Which of the following places would you have preferred to get the help you needed for your emotions, mental health or use of alcohol or drugs?

Select all that apply.

Family doctor or pediatrician's office
School
Mental health professional's office, such as a psychologist, psychiatrist, social worker or other counselor
Community mental health or addictions agency or clinic
Walk-in clinic
Urgent care clinic or emergency room
Hospital
Phone helpline or crisis hotline (Include chat and text.)
Other
- Specify other reason

Oral health care

Now some questions about oral health care.

In the past 12 months, how often did [FNAME] experience any persistent or on-going mouth pain?

Include pain in teeth, gums, tongue, jaw, jaw joints.

Would you say:

Often
Sometimes
Rarely
Never
Don't know

In the past 12 months, how often did [FNAME] avoid eating particular foods because of problems with [his/her] mouth?

Exclude avoiding certain foods because of allergies, orthodontic treatments, and normal tooth processes such as teething and loose baby teeth.

Would you say:

Often
Sometimes
Rarely
Never
Don't know

Does [FNAME] have any untreated mouth problems?

Mouth problems are defined as any condition that causes pain or discomfort.

For example:

abscesses
gum issues such as pain and bleeding
jaw pain; temporomandibular joints (TMJ)
untreated cavities, fillings needing to be replaced
tooth pain
injuries
mouth sores.

Exclude braces or other orthodontic treatments.

Yes
No
Don't know

When was the last time [FNAME] saw a dentist, denturist, dental hygienist or any other dental specialist?

Services may have been provided in any setting where the oral health professional is licensed to practice.

Would you say:

Less than one year ago
1 year to less than 3 years ago
3 years ago or more
Never seen an oral health professional
Don't know

In the past 12 months, have you avoided taking [FNAME] to an oral health professional for dental care due to the cost of care?

An oral health professional may include a dentist, denturist, dental hygienist or any other dental specialist.

Yes
No
Don't know

In the past 12 months, were there any other reasons that [FNAME] did not get dental care or treatment?

Select all that apply.

Would you say:

Did not feel it was necessary
Indirect costs (e.g., childcare, transportation)
Service not available in our area
There was a waitlist
Oral health professional office was not open at a convenient time
Afraid or anxious or do not like receiving oral health care
Too busy
Health related reasons
Language barriers
Did not know where to where to do to get treatment
I feel that [FNAME] is too young
Other reason
- Specify other reason
OR
No, none of the above
OR
Don't know

Are [FNAME]'s dental expenses fully or partially covered by any insurance plan or government program?

Yes
What type of insurance plan or government program?
Select all that apply.
- A plan through an employer
  Include plans that are partially paid or sponsored by an employer.
- A private plan
  Include personally purchased plans.
- The Canadian Dental Care Plan
- A government paid plan other than the Canadian Dental Care Plan
  e.g., children's dental program, Régie de l'assurance maladie du Québec (RAMQ), Non-insured Health Benefits (NIHB) for First Nations and Inuit
- A plan through college or university
OR
Don't know
No
Don't know

Injury and poisoning

The following questions are about poisonings that [FNAME] may have had during the past 12 months that were serious enough to limit [his/her] normal activities.

In the past 12 months, did [FNAME] have any poisonings?

Include poisoning by alcohol, cannabis, pharmaceuticals, illicit drugs, and chemicals, including pesticides, heavy metals, gases or vapors, and common household substances, such as bleach and ammonia.

Exclude food poisoning, poison ivy, allergies and skin inflammations caused by an allergic reaction.

Yes
Was it by:
Select all that apply.
- Alcohol
- Cannabis
- A medicine or drug
- A chemical
- Other
No

Was a health care professional consulted for [this poisoning/any of these poisonings]?

Include health care professionals from poison centres, paramedics, emergency rooms, family doctor clinic, walk-in clinic, etc.

The following questions are about injuries that [FNAME] may have had during the past 12 months that were serious enough to limit [his/her] normal activities.

In the past 12 months, did [FNAME] have any of the following types of injuries that were serious enough to limit [his/her] normal activities?

Exclude repetitive strain injuries and chronic back pain.

Select all that apply.

Was it:

Head injury
Include concussions and other traumatic brain injuries, skull or facial fracture.
Exclude superficial head injuries such as a cut or scrape.
Broken or fractured bones
Exclude skull or facial fracture.
Burn, scald or chemical burn
Dislocation
Sprain or strain
e.g., torn ligaments or muscles, back strain
Cut or puncture
Scrape, bruise or blister
Animal or human bite
Injury to internal organs
Other
- Specify the type of injury
OR
No, none of the above

In the past 12 months, did [FNAME] sustain any of the previously mentioned injuries as a result of a fall?

Include events where [FNAME] came into contact with the ground or any surface at a lower level than where [he/she] was previously, for example by falling from furniture, playground equipment, a window, or a balcony, or by losing his balance.

In the past 12 months, what was the most serious injury that [FNAME] had as a result of a fall?

The most serious injury was the one that imposed the greatest restriction on normal activities.

Was it:

Head injury
Include concussions and other traumatic brain injuries, skull or facial fracture.
Exclude superficial head injuries such as a cut or scrape.
Broken or fractured bones
Exclude skull or facial fracture.
Burn, scald or chemical burn
Dislocation
Sprain or strain
e.g., torn ligaments or muscles, back strain
Cut or puncture
Scrape, bruise or blister
Animal or human bite
Injury to internal organs
Other
[Another injury/[IAP_S15]/Not applicable]

The next questions refer to [FNAME]'s most serious fall-related injury that occurred in the past 12 months.

Which option best describes how this fall happened?

Was it:

Playing on playground equipment
Include indoor or outdoor gym or playground, jungle gym, bouncy castles, trampoline, falls from height on playground equipment
Riding or being a passenger on a bike or small wheeled device
Include non-motorized or motorized: bike, scooter, skateboard, hoverboard.
Exclude mobility devices such as wheelchair, mobility scooter.
Doing a sport or recreational activity
Exclude playing on playground equipment, riding a bike or small wheeled device.
Falling from furniture
Include bed, bunk bed, chair, sofa, table, counter, crib, change table, highchair.
Going up or down stairs or steps
Tripping or slipping
Exclude while doing a sport or recreational activity, playing on playground equipment, while going up or down stairs.
Other falls from a height
Include balcony, window, roof, ladder, tree.
Exclude playground equipment, furniture, stairs.
Other
- Specify how this fall happened

Was a health care professional consulted for the injury resulting from this fall?

Earlier, you mentioned that [FNAME] had a head injury. How many times did [he/she] have a head injury in the past 12 months?

Include concussions and other traumatic brain injuries, skull, or facial fracture.

Exclude superficial head injuries such as a cut or scrape.

Number of times

The next questions refer to the most serious head injury that occurred in the past 12 months. The most serious head injury was the one that imposed the greatest restriction on normal activities.

It is possible that the event where [FNAME]'s most serious head injury occurred is the same event as the fall you described earlier in question 104. If so, please report the same activity again.

What was [FNAME] doing when [his/her] most serious head injury occurred?

Include concussions and other traumatic brain injuries, skull or facial fracture.

Exclude superficial head injuries such as a cut or scrape.

Was it:

Playing on playground equipment
Include indoor or outdoor gym or playground, jungle gym, bouncy castles, trampoline, falls from height on playground equipment
Riding or being a passenger on a bike or small wheeled device
Include non-motorized or motorized: bike, scooter, skateboard, hoverboard.
Exclude mobility devices such as wheelchair, mobility scooter.
Doing a sport or recreational activity
Exclude playing on playground equipment, riding a bike or small wheeled device.
Falling from furniture
Include bed, bunk bed, chair, sofa, table, counter, crib, change table, highchair.
Going up or down stairs or steps
Tripping or slipping
Exclude while doing a sport or recreational activity, playing on playground equipment, while going up or down stairs.
Other falls from a height
Include balcony, window, roof, ladder, tree.
Exclude playground equipment, furniture, stairs.
Riding or driving a motor vehicle
Include on-road and off-road motor vehicles, being a passenger.
Being assaulted or victimized
Include if on purpose by another person to cause injuries (e.g., being hit, kicked, attacked, harassed, abused, bullied).
Other activity
- Specify the activity

Was a health professional consulted for this most serious head injury?

Include concussions and other traumatic brain injuries, skull, or facial fracture.

Exclude superficial head injuries such as a cut or scrape.

School, home and friends

We are interested in how you feel about yourself and how you think other people see you. For each of the following statements, please use "really false for me, sort of false for me, sort of true for me, really true for me" to describe your feelings and ideas in the past week.

I feel I do things well at school
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
My teachers like me and care about me
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
I feel free to express myself at home
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
I feel my teachers think I am good at things
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
I like to spend time with my parents
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
I feel free to express myself with my friends
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
I feel I do things well at home
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
My parents like me and care about me
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
I feel I have a choice about when and how to do my school work
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
I feel my parents think that I am good at things
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
I like to be with my teachers
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
I feel I have a choice about which activities to do with my friends
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
I feel I do things well when I am with my friends
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
My friends like me and care about me
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
I feel free to express myself at school
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
I feel my friends think I am good at things
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
I like to spend time with my friends
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me
I feel like I have a choice about when and how to do my household chores
- Really false for me
- Sort of false for me
- Sort of true for me
- Really true for me

Weight, shape and muscles

The next questions ask about your thoughts and behaviours over the past 4 weeks, including how you may have felt about your weight, shape, or muscles, and your eating habits.

In the last 4 weeks, how often did you worry so much about your weight, shape, or muscles that you couldn't get it out of your head?

Never
Rarely
Sometimes
Often
Always

In the last 4 weeks, how often did you...

not eat, or eat in a way to change your weight, shape, or muscles?
- Never
- Once or twice
- Once or twice each week
- 3 or 4 times each week
- 5 or 6 times each week
- Daily or almost daily
binge on food?
i.e., eaten what other people would say is an unusually large amount of food such as a whole litre of ice cream, in a few hours.
- Never
- Once or twice
- Once or twice each week
- 3 or 4 times each week
- 5 or 6 times each week
- Daily or almost daily
feel like you couldn't stop eating or couldn't control how much you ate?
- Never
- Once or twice
- Once or twice each week
- 3 or 4 times each week
- 5 or 6 times each week
- Daily or almost daily
vomit or take laxatives to control your weight, shape or muscles?
- Never
- Once or twice
- Once or twice each week
- 3 or 4 times each week
- 5 or 6 times each week
- Daily or almost daily
take any pills, powders, or liquids without a doctor's advice to control your weight, shape or muscles?
- Never
- Once or twice
- Once or twice each week
- 3 or 4 times each week
- 5 or 6 times each week
- Daily or almost daily

Substance use

The following questions are about your experience with several types of substances.

Again, Statistics Canada would like to remind you that all your answers will remain strictly confidential.

Not counting small sips, have you ever had a drink of alcohol?

A "drink" refers to:

a small bottle, draft or can of beer, cider or cooler
a glass of wine
a cocktail or glass containing 1.5 ounces of liquor.

Not counting small sips, how old were you when you had your first drink of alcohol?

In the past 12 months, how often did you drink alcohol - liquor (rum, whisky, etc.), wine, beer, or coolers?

Would you say:

Never
Less than once a month
Once a month
2 to 3 times a month
Once a week
2 to 3 times a week
4 to 5 times a week
Daily or almost daily

How often in the past 12 months have you had [4/5] or more drinks on one occasion?

Would you say:

Never
Less than once a month
Once a month
2 to 3 times a month
Once a week
More than once a week

In the past 30 days, how often did you drink alcoholic beverages?

Would you say:

Never
Less than once a week
Once a week
2 to 3 times a week
4 to 5 times a week
Daily or almost daily

The following questions are about your experiences with smoking cigarettes.

Exclude cigars, little cigars, cigarillos, water-pipes and e-cigarettes.

Have you ever smoked a whole cigarette?

In your lifetime, have you smoked a total of 100 or more cigarettes (about 4 packs)?

In the past 30 days, how often did you smoke cigarettes?

Would you say:

Never
Less than once a week
Once a week
2 to 3 times a week
4 to 6 times a week
Daily

Now questions about electronic cigarettes (e-cigarettes) or vaping devices.

Have you ever tried an e-cigarette or vaping device, also known as a vape?

Include vaping e-liquid with nicotine and without nicotine i.e., just flavouring.

Exclude vaping cannabis.

At what age did you first use an e-cigarette or vaping device?

In the past 30 days, how often did you use an e-cigarette or vaping device?

Would you say:

Never
Less than once a week
Once a week
2 to 3 times a week
4 to 6 times a week
Daily

The last time you used an e-cigarette or vaping device, also known as a vape, what did it contain?

An e-cigarette or a vaping device with nicotine
An e-cigarette or a vaping device without nicotine
e.g., just flavouring
An e-cigarette or a vaping device but you did not know what it contained

The next few questions are about the use of cannabis for medical and non-medical purposes. The term "cannabis" refers to marijuana, hashish, hash oil or any other product of the cannabis plant.

Have you ever used or tried cannabis?

At what age did you first try cannabis?

How often did you use cannabis in the past 12 months?

Report the average use in the last 12 months.

Would you say:

Never
Less than once a month
1 to 3 times a month
Once a week
More than once a week
Daily or almost daily

In the past 12 months, which of the following cannabis products have you used?

Select all that apply.

Would you say:

Dried flower or leaf
Hashish
e.g., hash, hash oil
Cannabis oil for oral use
e.g., capsules, spray, tincture
Cannabis vape pens or cartridges
Cannabis concentrates
e.g., shatter, budder, butane honey oil
Cannabis edible food products
e.g., baked goods, candy, other foods
Cannabis beverages
e.g., cola, tea, coffee
Topicals
e.g., lotion, ointment, creams applied to skin
Other
e.g., seeds
Specify other product

In the past 30 days, how often did you use cannabis?

Would you say:

Never
Less than once a week
1 to 2 days a week
3 to 4 days a week
5 to 6 days a week
Daily

How easy or difficult would it be for you to get cannabis or marijuana if you wanted some?

Would you say:

Very difficult
Fairly difficult
Fairly easy
Very easy
Don't know

Tobacco products alternatives

The following questions are about your use of tobacco and nicotine products other than cigarettes and e-cigarettes.

In the past 30 days, did you use any of the following tobacco products other than cigarettes and e-cigarettes?

Nicotine pouch
These products are sometimes called "white pouches". These products do not contain tobacco; they are smokeless and spit-free.
e.g., Zonnic®, Zyn®, On!®, Lyft®, Velo®, Nordic Spirit®, Sesh® or Shiro®
- Yes
- No
Nicotine gum, nicotine lozenge, nicotine patch, nicotine mouth spray, nicotine nasal spray, or nicotine inhaler
e.g., Thrive lozenge, Nicoderm patch, Nic-Hit spray, Nicorette gum or Nicorette inhalers
- Yes
- No
Cigars, cigarillos, or little cigars, a pipe, chewing tobacco, or a tobacco water-pipe
Include snuff, pinch, hookah, shisha, nargeelay, hubble-bubble or gouza.
- Yes
- No
A heated tobacco product, also known as a "heat-not-burn" product
e.g., iQOS™ or Glo™
- Yes
- No

In the past 30 days, how often did you use a nicotine pouch that you put in your mouth?

Every day
At least once a week
At least once in the past month

Drug and medication use

The following questions are about other drugs and medications used to get high or to improve performance and not to follow any health care provider recommendations or prescriptions.

In the past 12 months, have you used or tried any of these drugs or medications to get high or to improve performance?

Exclude any drugs or medications used for a medical reason or prescribed by a health care professional.

Select all that apply.

Amphetamines
Also called speed, crystal meth or ice, meth, crank
Cocaine
Also called crack, blow, snow, rock, freebase
Heroin
Also called smack, junk, horse
MDMA or 3-4 methylenedioxymethamphetamine
Also called ecstasy, E, X, molly
Opioid or fentanyl painkillers
Also called dillies, oxy, percs, hydro, greenies, Apache, China White
e.g., codeine, oxycodone, fentanyl or fent, morphine, T3, Dilaudid, Percocet
Exclude over-the-counter medications such as Aspirin®, Tylenol®, Advil® or Motrin®.
Hallucinogens
Also called LSD or lysergic acid diethylamide, acid, magic mushrooms or "shrooms", mesc, tryptamines, DMT, "psychosis", AMT, foxy
ADD or ADHD medicine
e.g., Ritalin®, Concerta®, Adderall®, Dexedrine®, Vyvanse®
Also called addys, bennies, dexies
Sedatives or anti-anxiety medicine
e.g., Benzodiazepine or "benzos", Ativan®, Xanax®, Valium®, Rivotril®, Ambien®, Lunesta®, Sublinox®
Also called roofies, xans, tranks
Diet pills
Performance enhancing drugs for sports and muscle size
e.g., Depo-Testosterone®, muscle, roids, anabolic steroids
Other drugs or medications not used for medical reasons nor prescribed by a health care professional
- Specify other drugs or medications
OR
None of the above

Moderate physical activity

Thinking of the past 7 days, we would like to record [[FNAME]'s/your] total time spent doing various types of physical activities. Please do not report the same physical activity in more than one of the following questions.

In the past 7 days, did [[FNAME]/you] use active transportation like walking or cycling to get to places?

Active transportation is using non-motorized, human-powered movement to get from one place to another.

Exclude walking, cycling or other activities done purely for leisure. These activities will be asked about later.

Include using active transportation to go to school, daycare or childcare, shopping centres or to visit friends.

In the past 7 days, how much time in total, did [you/[he/she]] spend using active transportation to get to places?

Hours per week
Minutes per week

In the past 7 days, did [[FNAME]/you] do physical activities while at school as part of physical education classes, lunch hour, recess, school teams or clubs?

Exclude physical activity you have already reported in this questionnaire.

Include activities organized by the school, regardless of location and whether they take place before or after regular school hours.

Yes
Did any of these physical activities make [[him/her]/you] sweat at least a little or breathe harder?
- Yes
- No
No

In the past 7 days, how much time in total did [[FNAME]/you] spend doing physical activity while at school that made [[him/her]/you] sweat at least a little or breathe harder?

Hours per week
Minutes per week

In the past 7 days, did [[FNAME]/you] do physical activities outside of school as part of [[his/her]/your] leisure time?

Exclude physical activity you have already reported in this questionnaire.

Include exercising, playing an organized or non-organized sport or actively playing with friends.

e.g., dance, hockey, martial arts, soccer, pick-up game of basketball, playing at the park, walking or cycling for leisure, hiking.

Yes
Did any of these physical activities make [[him/her]/you] sweat at least a little or breathe harder?
- Yes
- No
No

In the past 7 days, how much time in total did [[FNAME]/you] spend doing physical activities outside of school that made [[him/her]/you] sweat at least a little or breathe harder?

Hours per week
Minutes per week

In the past 7 days, did [[FNAME]/you] do tasks that involved being physically active as part of household chores, volunteering, paid or unpaid work?

e.g., cutting grass or yard work, vacuuming or mopping, washing windows.

Exclude physical activity you have already reported in this questionnaire.

Yes
Did any of these physical activities make [[him/her]/you] sweat at least a little or breathe harder?
- Yes
- No
No

In the past 7 days, how much time in total did [[FNAME]/you] spend doing tasks that involved being physically active as part of household chores, volunteering, paid or unpaid work and that made [[him/her]/you] sweat at least a little or breathe harder?

Hours per week
Minutes per week

In the past 7 days, how many hours per day did [FNAME] actively play?

Include: energetic play indoors or outdoors, for example, playing tag or ball games, crawling or running around, riding a bike or scooter, and swinging, climbing, or sliding on play structures.

Exclude: light intensity activities such as standing up, walking around, or playing with toys or in the sand or snow while seated.

Never
Less than 30 minutes per day
30 minutes to less than 1 hour per day
1 to less than 2 hours per day
2 to less than 3 hours per day
3 or more hours per day

In the previous questions, [[FNAME]/you] recorded a total time spent doing various types of physical activities of: [Sum of hours and minutes] in the past 7 days.

This includes active transportation and physical activities that made [[him/her]/you] sweat at least a little or breathe harder.

If this is correct, please click "Next" to continue. If not, please return and correct.

Parent-child interaction

How often…

do you praise [FNAME] by saying something like "Good for you!" or "What a nice thing you did!" or "That's good going!"?
- Never
- About once a week or less
- A few times a week
- One or two times a day
- Many times a day
do you and [FNAME] talk or play with each other, focusing attention on each other for five minutes or more, just for fun?
- Never
- About once a week or less
- A few times a week
- One or two times a day
- Many times a day
do you and [FNAME] laugh together?
- Never
- About once a week or less
- A few times a week
- One or two times a day
- Many times a day
do you do something special with [FNAME] that [he/she] enjoys?
- Never
- About once a week or less
- A few times a week
- One or two times a day
- Many times a day
do you play sports, hobbies or games with [FNAME]?
- Never
- About once a week or less
- A few times a week
- One or two times a day
- Many times a day

Eating Habits

The next questions are about some of [[FNAME]'s/your] eating and drinking habits.

In the past 30 days, how many meals did [[FNAME]/you] eat that were prepared away from home in places such as restaurants, fast-food places, grocery stores, or delivery?

Exclude meals provided as part of a daycare meal plan, school-provided lunch or breakfast program.

Include fast-food, take-out, sit-down restaurants, prepared food from grocery stores, and paid school lunches where restaurant food was brought in (e.g., pizza days)

Frequency can be reported per month, per week or per day.

Number of times
Per month, per week or per day
- Per month
- Per week
- Per day

How many of those meals did [[FNAME]/you] eat from a fast-food restaurant (e.g., burgers, pizza, hot dogs, fried potatoes, fried chicken, submarines or sandwiches, tacos, etc.)?

Frequency can be reported per month, per week or per day.

Number of times
Per month, per week or per day
- Per month
- Per week
- Per day

In the past 30 days, how many times did [[FNAME]/you] drink the following beverages?

Please note that some of the foods listed are regional and may not be available where you live.

Frequency can be reported per month, per week or per day.

100% pure fruit juice
- Number of times
- Per month, per week or per day
  - Per month
  - Per week
  - Per day
Fruit flavoured drinks or sports drinks
e.g., Fruité™, fruit punch, Gatorade™
Exclude artificially sweetened drinks.
- Number of times
- Per month, per week or per day
  - Per month
  - Per week
  - Per day
Regular soft drinks
Exclude diet soft drinks.
- Number of times
- Per month, per week or per day
  - Per month
  - Per week
  - Per day
Sweetened coffee drinks or iced tea
e.g., Starbucks™ Macchiato, Tim Hortons Ice Capp™, Nestea™, coffee or tea with sugar added
- Number of times
- Per month, per week or per day
  - Per month
  - Per week
  - Per day
Energy drinks
e.g., Red Bull™, Monster™
- Number of times
- Per month, per week or per day
  - Per month
  - Per week
  - Per day
Sweetened flavoured milk or sweetened plant-based beverage
e.g., Chocolate, strawberry or vanilla Milk2Go™, Earth's Own original oat milk™, Silk almond vanilla™, Neilson CARAMILK ™or Crispy Crunch milkshake™, Nesquik™
Exclude yogurt drinks.
- Number of times
- Per month, per week or per day
  - Per month
  - Per week
  - Per day

In the past 30 days, how many times did [[FNAME]/you] eat the following fruits and vegetables?

Please note that some of the foods listed are regional and may not be available where you live.

Include fresh, frozen, canned or dried.

Include only foods that [[FNAME]/you] actually consumed.

Frequency can be reported per month, per week or per day.

Fruits
Exclude fruit juices.
- Number of times
- Per month, per week or per day
  - Per month
  - Per week
  - Per day
Dark green vegetables
e.g., broccoli, green beans, dark lettuce, spinach
- Number of times
- Per month, per week or per day
  - Per month
  - Per week
  - Per day
Orange-coloured vegetables
e.g., carrots, orange bell peppers, sweet potatoes
- Number of times
- Per month, per week or per day
  - Per month
  - Per week
  - Per day
Starchy vegetables
e.g., white potatoes, corn
Exclude deep fried potatoes.
- Number of times
- Per month, per week or per day
  - Per month
  - Per week
  - Per day
Other vegetables
e.g., cucumber, celery, cabbage, tomatoes, cauliflower
- Number of times
- Per month, per week or per day
  - Per month
  - Per week
  - Per day

Canada's Food Guide use

[Has/Have] [FNAME/you] ever seen or heard of Canada's Food Guide?

Yes
No
Don't know

Have you ever used information from Canada's Food Guide?

What did you use the information for?

Select all that apply.

Would you say:

To choose foods
To determine how much to eat every day
To plan meals or to help with grocery shopping
To assess how well you are eating
Other

Food advertising

The following questions are about advertisements on food and drinks.

How often does [FNAME] ask you to buy food or drinks [he/she] has seen advertised?

e.g., soda or pop, sports and energy drinks; juice and flavoured milks; fast food; sugary cereals; chips, crackers and granola bars; desserts and treats

Advertisements include those on tv, social media, on food packages, on billboards, etc.

Would you say:

Very frequently
Frequently
Occasionally
Rarely
Very rarely
Never

In general, how often do you buy these foods or beverages requested by [FNAME]?

e.g., soda or pop, sports and energy drinks; juice and flavoured milks; fast food; sugary cereals; chips, crackers and granola bars; desserts and treats

Would you say:

Very frequently
Frequently
Occasionally
Rarely
Very rarely
Never

Healthy living and electronic devices

Now a few questions about [[FNAME]'s/your] sleep habits in the past 7 days.

On a typical day, how much time in total did [[FNAME]/you] sleep, [including/excluding] any time spent napping?

Weekday
- Hours per day
- Minutes per day
Weekend day
- Hours per day
- Minutes per day

In the past 7 days, how often did [FNAME] have trouble sleeping?

Would you say:

Never
Rarely
Sometimes
Most of the time
All the time

In the past 7 days, how often did [[FNAME]/you] have trouble going to sleep or staying asleep?

Would you say:

Never
Rarely
Sometimes
Most of the time
All the time

For the next question, think about all the time [[FNAME]/you] used any electronic device in [his/her/your] free time in the past 7 days.

In the past 7 days, how much time on a typical day did [[FNAME]/you] spend using any electronic device such as a mobile device, computer, tablet, video game console or television while [he/she/you] [was/were] sitting or lying down?

Exclude time spent in class, doing homework, or reading for enjoyment.

Weekday
- Hours per day
- Minutes per day
Weekend day
- Hours per day
- Minutes per day

Food Security

The following statements may describe the food situation for your household in the past 12 months. Please indicate if the statement was often true, sometimes true, or never true for [you/you and other household members].

[You/You and other household members] worried that food would run out before you got money to buy more
- Often true
- Sometimes true
- Never true
The food that [you/you and other household members] bought just didn't last and there wasn't any money to get more
- Often true
- Sometimes true
- Never true
[You/You and other household members] couldn't afford to eat balanced meals
- Often true
- Sometimes true
- Never true
[You/You or other adults in your household] relied on only a few kinds of low-cost food to feed [[FNAME]/the children] because you were running out of money to buy food
- Often true
- Sometimes true
- Never true
[You/You or other adults in your household] couldn't feed [[FNAME]/the children] a balanced meal because you couldn't afford it
- Often true
- Sometimes true
- Never true

[[FNAME] was/The children were] not eating enough because [you/you or other adults in your household] just couldn't afford enough food.

Would you say:

Often true
Sometimes true
Never true

The following few questions are about the food situation in the past 12 months for you or any other adults in your household.

In the past 12 months, since last [January/February/March/April/May/June/July/August/September/October/November/December], did [you/you or other adults in your household] ever cut the size of your meals or skip meals because there wasn't enough money for food?

Yes
How often did this happen?
Was it:
- Almost every month
- Some months but not every month
- Only 1 or 2 months
No

In the past 12 months, did you (personally) ever eat less than you felt you should because there wasn't enough money to buy food?

In the past 12 months, were you (personally) ever hungry but didn't eat because you couldn't afford enough food?

In the past 12 months, did you (personally) lose weight because you didn't have enough money for food?

In the past 12 months, did [you/you or other adults in your household] ever not eat for a whole day because there wasn't enough money for food?

Yes
How often did this happen?
Was it:
- Almost every month
- Some months but not every month
- Only 1 or 2 months
No

Now, a few questions on the food experiences for children in your household.

In the past 12 months, did [you/you or other adults in your household] ever cut the size of [[FNAME]'s/any of the children's] meals because there wasn't enough money for food?

In the past 12 months, did [[FNAME]/any of the children] ever skip meals because there wasn't enough money for food?

Yes
How often did this happen?
Was it:
- Almost every month
- Some months but not every month
- Only 1 or 2 months
No

In the past 12 months, [was [FNAME]/were any of the children] ever hungry but you just couldn't afford more food?

In the past 12 months, did [[FNAME]/any of the children] ever not eat for a whole day because there wasn't enough money for food?

School attendance

In a typical week, does [FNAME] attend school?

e.g., any level of kindergarten, primary, secondary, post-secondary

Exclude online learning, homeschooling and any child care such as daycare and preschool.

What is the main reason that [FNAME] is not currently attending school?

Is it:

[FNAME] is too young to attend school
[FNAME] is homeschooled
Illness
Dropped out
Graduated from high school and planning to attend post-secondary school
Graduated from high school and not currently planning to attend post-secondary school
Graduated from both high school and post-secondary school
Other
- Specify other reason

School food programs

The next few questions are about school food programs. These programs regularly provide meals or snacks to children to help children have access to nutritious food. These programs are typically free or offered at a lower cost.

Thinking about this definition, would you say [[FNAME]'s/your] school has a school food program that offers snacks or meals at a lower cost or free?

Include breakfast, lunch and snack programs that provide foods such as cereal, fruits, sandwiches, pasta, yogurt, granola bars, etc.
Do not count food paid for at full cost from a canteen, cafeteria or ordered from a restaurant, and occasional lunches such as "pizza days".

Yes
No
Does not apply to me
e.g., I don't go to school, I attend home-school, I attend school online
Don't know

[Has/Have] [[FNAME]/you] ever used the school food program at [his/her/your] current school?

Yes
No
Don't know

How often [does/do] [[FNAME]/you] usually eat meals or snacks from the school food program?

Would you say:

Less than once a week
Once a week
A few days a week
Every school day

What type of meal or snack from the school food program [does/do] [[FNAME]/you] usually eat?

Select all that apply.

Would you say:

Breakfast
Lunch
Snack
Other
- Specify other type of meal or snack

What are the benefits of [[FNAME]'s/your] participation in the school food program?

Select all that apply.

Would you say:

It saves money on food and groceries
It saves time and energy on preparing food
[He/She/You] [is/are] less hungry while at school
[He/She/You] eat[s/] healthy food
[He/She/You] [is/are] more motivated to go to school
[He/She/You] [is/are] better able to focus in class
[He/She/You] feel[s/] included with other children
[He/She/You] learn[s/] about healthy food, where food comes from, or reducing food waste
The program serves food aligned with [[FNAME]'s/your] culture or religion
[He/She/You] explore[s/] new foods that [he/she/you] might not normally try
Other
- Specify other benefit
OR
There is no benefit

Child Care Services

The following questions are about [FNAME] and [his/her] usual child care arrangements.

By child care arrangements, we mean any care provided to children by someone other than the parent or guardian, including formal and informal arrangements, licensed and unlicensed arrangements, full-time and part-time arrangements as well as paid and unpaid arrangements.

In the past three months, did [FNAME] usually attend any child care arrangements?

Include:

use of daycare facilities, home-based child care providers, or before or after school programs, pre-school programs
child care provided by a relative other than a parent or guardian, for example, a grandparent or sibling
child care provided by a non-relative in the child's home, for example, a nanny.

Exclude:

parents or guardians looking after their own children, including homeschooling
child care provided by the child's own parent or guardian operating a home-based child care business
school attendance, for example, any level of kindergarten, pre-primary, grade primary, primary and elementary school
school lunch supervision
occasional babysitting.

In the past three months, which of the following child care arrangements did you usually use for [FNAME]?

Select all that apply.

Before or after school program
e.g., a program located in a school, a community centre, a library, etc.
Daycare centre, preschool or centre de la petite enfance (CPE)
Child care by a relative other than a parent or guardian
e.g., a grandparent or sibling
Child care by a non-relative in the child's home
e.g., a nanny
Home-based child care provider
e.g., family child care home or home-based daycare service
Other child care arrangement
- Specify other child care arrangement

Family History

The following questions are about [[FNAME]'s/your] family.

[Has [FNAME]/Have you] experienced the separation or divorce of a parent?

Does [FNAME] have a living parent or guardian who does not reside in this household?

In the past 12 months, what type of contact has [FNAME] had with the other parent or guardian?

Would you say:

Lives equally with both parents or guardians
Overnight visits
In-person visits, but did not stay overnight
Video call or chat, telephone, letter or email contact only
No contact
Other

In the past 12 months, how often did the other parent or guardian contact [FNAME] when [he/she] was not living at the other parent or guardian's household?

Include phone calls, text messages, emails or video chats.

Daily
At least once a week
At least once a month
Less than once a month
Not at all

Sexual orientation

This question collects information on sexual orientation to inform programs that promote equal opportunity for everyone living in Canada to share in its social, cultural, and economic life.

What is your sexual orientation?

Sexual orientation refers to how a person describes their sexuality.

Would you say:

Heterosexual (i.e., straight)
Lesbian or gay
Bisexual or pansexual
Or please specify
- Specify your sexual orientation

Language

The following sections consist of demographic questions about the identified individual or individuals. Please answer each question to the best of your knowledge.

Can [this person/you] speak English or French well enough to conduct a conversation?

For a child who has not yet learned to speak, report the language(s) that the child is learning to speak at home.

> [FNAME] :

English only
French only
Both English and French
Neither English nor French

> You:

English only
French only
Both English and French
Neither English nor French

> [First name of PMK spouse/Your spouse or partner]:

English only
French only
Both English and French
Neither English nor French

What language [does this person/do you] speak most often at home?

For a child who has not yet learned to speak, report the language spoken most often to this child at home.

> [FNAME] :

English
French
Other
- Specify other language

> You:

English
French
Other
- Specify other language

> [First name of PMK spouse/Your spouse or partner]:

English
French
Other
- Specify other language

Place of birth, immigration and citizenship

Where was this person born?

Specify place of birth according to present boundaries.

> [FNAME] :

Born in Canada
Born outside Canada
- Select the country
  To search for a country, type the first few letters to narrow down the choices.
  Note: If the country is not listed, select "Other".
  - Specify other country

> You:

Born in Canada
Born outside Canada
- Select the country
  To search for a country, type the first few letters to narrow down the choices.
  Note: If the country is not listed, select "Other".
  - Specify other country

> [First name of PMK spouse/Your spouse or partner]:

Born in Canada
Born outside Canada
- Select the country
  To search for a country, type the first few letters to narrow down the choices.
  Note: If the country is not listed, select "Other".
  - Specify other country

In what year did this person first come to Canada to live?

If exact year is not known, enter best estimate.

> [FNAME] :

Year of arrival

> You:

Year of arrival

> [First name of PMK spouse/Your spouse or partner]:

Year of arrival

Is this person now, or has this person ever been a landed immigrant?

A "landed immigrant" (permanent resident) is a person who has been granted the right to live in Canada permanently by immigration authorities.

> [FNAME] :

Yes
In what year did [[FNAME]/you] first become a landed immigrant?
If exact year is not known, enter best estimate.
- Year of immigration
No

> You:

Yes
In what year did you first become a landed immigrant?
If exact year is not known, enter best estimate.
- Year of immigration
No

> [First name of PMK spouse/Your spouse or partner]:

Yes
In what year did this person first become a landed immigrant?
If exact year is not known, enter best estimate.
- Year of immigration
No

Of what country is this person a citizen?

Indicate more than one citizenship, if applicable.

> Is [FNAME] a citizen of:
Select all that apply.

Canada
Is it:
- By birth
- By naturalization
  i.e., the process by which an immigrant is granted citizenship of Canada, under the Citizenship Act.
Another country

> Are you a citizen of :
Select all that apply.

Canada
Is it:
- By birth
- By naturalization
  i.e., the process by which an immigrant is granted citizenship of Canada, under the Citizenship Act.
Another country

> Is [First name of PMK spouse/your spouse or partner] a citizen of:
Select all that apply.

Canada
Is it:
- By birth
- By naturalization
  i.e., the process by which an immigrant is granted citizenship of Canada, under the Citizenship Act.
Another country

Indigenous identity

Is this person First Nations, Métis or Inuk (Inuit)?

First Nations (North American Indian) includes Status and Non-Status Indians.
If "Yes", select the responses that best describes this person now.

> [FNAME] :

No, not First Nations, Métis or Inuk (Inuit)
OR
Yes, First Nations (North American Indian)
Yes, Métis
Yes, Inuk (Inuit)

> You:

No, not First Nations, Métis or Inuk (Inuit)
OR
Yes, First Nations (North American Indian)
Yes, Métis
Yes, Inuk (Inuit)

> [First name of PMK spouse/Your spouse or partner]:

No, not First Nations, Métis or Inuk (Inuit)
OR
Yes, First Nations (North American Indian)
Yes, Métis
Yes, Inuk (Inuit)

Sociodemographic characteristics

The following question collects information to support programs that promote equal opportunity for everyone to share in the social, cultural and economic life of Canada.

Which population group or groups best describe this person?

Select all groups that apply, or specify another group, if applicable.

> [FNAME] :

White
South Asian
For example, Indian, Pakistani, Sri Lankan
Chinese
Black
Filipino
Arab
Latin American
Southeast Asian
For example, Vietnamese, Cambodian, Laotian, Thai
West Asian
For example, Iranian, Afghan
Korean
Japanese
Or please specify
- Specify another group

> You:

White
South Asian
For example, Indian, Pakistani, Sri Lankan
Chinese
Black
Filipino
Arab
Latin American
Southeast Asian
For example, Vietnamese, Cambodian, Laotian, Thai
West Asian
For example, Iranian, Afghan
Korean
Japanese
Or please specify
- Specify another group

> [First name of PMK spouse/Your spouse or partner]:

White
South Asian
For example, Indian, Pakistani, Sri Lankan
Chinese
Black
Filipino
Arab
Latin American
Southeast Asian
For example, Vietnamese, Cambodian, Laotian, Thai
West Asian
For example, Iranian, Afghan
Korean
Japanese
Or please specify
- Specify another group

Education

What is the highest certificate, diploma or degree that this person has completed?

> You:

Less than high school diploma or its equivalent
High school diploma or a high school equivalency certificate
Trades certificate or diploma
College, CEGEP or other non-university certificate or diploma (other than trades certificates or diplomas)
University certificate or diploma below the bachelor's level
Bachelor's degree
e.g., B.A., B.A. (Hons), B.Sc., B.Ed., LL.B.
University certificate, diploma or degree above the bachelor's level

> [First name of PMK spouse/Your spouse or partner]:

Less than high school diploma or its equivalent
High school diploma or a high school equivalency certificate
Trades certificate or diploma
College, CEGEP or other non-university certificate or diploma (other than trades certificates or diplomas)
University certificate or diploma below the bachelor's level
Bachelor's degree
e.g., B.A., B.A. (Hons), B.Sc., B.Ed., LL.B.
University certificate, diploma or degree above the bachelor's level

Labour market activities

Many of the following questions concern work activities last week.

Last week is from last [day of interview] to yesterday.

Last week, did this person work at a job or business?

Select "Yes" if this person worked at least one hour:

for pay (wages, salary, etc.)
in self-employment.

Select "No" if this person:

was away from work for the entire week for a reason such as vacation, illness, work schedule or layoff
did not have a job or business.

> You:

> [First name of PMK spouse/Your spouse or partner]:

Last week, did this person have a job or business from which he or she was absent?

Select "Yes" if this person:

was away from work for the entire week for a reason such as vacation, illness, parental leave or work schedule
was self-employed with a business, but no work was available.

Select "No" if this person:

did not have a job or business
had a casual job, but no work was available.

> You:

> [First name of PMK spouse/Your spouse or partner]:

What was the main reason this person was absent from work last week?

> You:

Vacation
Own illness or disability
Caring for own children
Caring for elder relative
60 years of age or older
Maternity or parental leave
Other personal or family responsibilities
Labour dispute (strike or lockout)
Employees only
Temporary layoff due to business conditions
Employees only
Seasonal layoff
Employees only
Casual job, no work available
Employees only
Work schedule
e.g., 10 days on, 10 days off, employees only
Self-employed, no work available
Self-employed only
Seasonal business
Excluding employees
Other, specify
- Specify the main reason you were absent from work last week

> [First name of PMK spouse/Your spouse or partner]:

Vacation
Own illness or disability
Caring for own children
Caring for elder relative
60 years of age or older
Maternity or parental leave
Other personal or family responsibilities
Labour dispute (strike or lockout)
Employees only
Temporary layoff due to business conditions
Employees only
Seasonal layoff
Employees only
Casual job, no work available
Employees only
Work schedule
e.g., 10 days on, 10 days off, employees only
Self-employed, no work available
Self-employed only
Seasonal business
Excluding employees
Other, specify
- Specify the main reason

Administrative information

To enhance the data from this survey and to minimize the reporting burden for respondents, [Statistics Canada and your provincial ministry of health and the Institut de la statistique du Québec/Statistics Canada and your ministry of health] may combine [your responses and [FNAME]'s/your responses] with information from other surveys or administrative sources.

[Does [FNAME]/Do you] have [a Newfoundland and Labrador/a Prince Edward Island/a Nova Scotia/a New Brunswick/a Quebec/an Ontario/a Manitoba/a Saskatchewan/an Alberta/a British Columbia/a Yukon/a Northwest Territories/a Nunavut] health number?

Having a provincial or territorial health number will assist us in linking to this other information.

For which province or territory is [[FNAME]'s/your] health number?

If you do not have a Canadian health number, select "No Canadian health number" from the dropdown.

Province or territory
- Alberta
- British Columbia
- Manitoba
- New Brunswick
- Newfoundland and Labrador
- Northwest Territories
- Nova Scotia
- Nunavut
- Ontario
- Prince Edward Island
- Quebec
- Saskatchewan
- Yukon
- No Canadian health number

What is [[FNAME]'s/your] health number?

Enter a health number for [Newfoundland and Labrador/Prince Edward Island/Nova Scotia/New Brunswick/Quebec/Ontario/Manitoba/Saskatchewan/Alberta/British Columbia/Yukon/the Northwest Territories/Nunavut]. In [Newfoundland and Labrador/Prince Edward Island/Nova Scotia/New Brunswick/Quebec/Ontario/Manitoba/Saskatchewan/Alberta/British Columbia/Yukon/the Northwest Territories/Nunavut], the health number is made up of [twelve numbers/eight numbers/ten numbers/nine numbers/four letters followed by eight numbers/ten numbers. Do not include the two letters at the end for green health cards/nine numbers, beginning with 002 or 003/one letter followed by seven numbers].

Do not insert blanks, hyphens or commas between the numbers.

[Note: In Manitoba, health numbers of a family's members can be listed on the same card. Be sure to capture [FNAME]'s health number if there is more than one on the card/Note: In British Columbia, residents may have a combined driver's license and health card. If [FNAME] has a combined card, the health number is on the back above the barcode./]

Health number

To avoid duplication of surveys, Statistics Canada has signed agreements to share the data from this survey with provincial and territorial ministries of health [and the Institut de la statistique du Québec]. Provincial or territorial ministries of health [and the Institut de la statistique du Québec] may make the data available to local health authorities.

Data shared with your ministry of health [and the Institut de la statistique du Québec] may also include identifiers such as name, address, telephone number and health card number. Local health authorities would receive only survey responses and the postal code.

These organizations have agreed to keep the data confidential and use it only for statistical purposes.

Do you agree to share the information [you and [FNAME]/you] provided?

To avoid duplication of surveys, Statistics Canada has signed agreements to share the data from this survey with provincial and territorial ministries of health [and the Institut de la statistique du Québec]. The [Institut de la statistique du Québec and] provincial or territorial ministries of health may make this data available to local health authorities.

These organizations have agreed to keep the data confidential and use it only for statistical purposes.

As a reminder, information about you collected through this survey includes the answers provided by you and those provided about you by your parent or legal guardian.

Do you give your consent for Statistics Canada to share the information about you that you and your parent or legal guardian provided as part of this survey with these organizations?

Thank you for completing the Canadian Health Survey on Children and Youth!

If applicable to your secondary school program, you can now request proof that confirms that you volunteered to complete the survey as part of your community involvement activities.

If you need this proof of participation, select "Yes" to the question below and confirm your contact information. Statistics Canada will send you an email with proof of participation by Spring 2027.

Do you need Statistics Canada to provide proof of participation in this survey?

So that Statistics Canada can provide you with proof of participation in this survey, please verify your contact information and correct it if necessary.

First name:
- Prefilled with [youth's first name]
Last name:
- Prefilled with [youth's last name]
Email:
- Prefilled with [email address]

Canadian Health Survey on Children and Youth - 2026

Getting started

Why are we conducting this survey?

Other important information

Authorization and confidentiality

Record linkages

Respondent Verification

Parent or legal guardian consent

Household composition

Contact information

Gender and sex at birth – pmk

Youth respondent verification

Marital status

General health

Height and weight

Long-term health conditions

Preterm birth status

Child functioning

Emotional behavioural scale

Pediatric symptom checklist

Regular health care provider

Electronic health information

Perceived need for care

Accessing mental health care

Oral health care

Injury and poisoning

School, home and friends

Weight, shape and muscles

Substance use

Tobacco products alternatives

Drug and medication use

Moderate physical activity

Parent-child interaction

Eating Habits

Canada's Food Guide use

Food advertising

Healthy living and electronic devices

Food Security

School attendance

School food programs

Child Care Services

Family History

Sexual orientation

Language

Place of birth, immigration and citizenship

Indigenous identity

Sociodemographic characteristics

Education

Labour market activities

Administrative information