Impact of the COVID-19 pandemic on self-reported health status and noise pollution in rural and non-rural Canada

Sample design

Example recruitment and response rate

A detailed presentation of the CPENS methodology is provided by Michaud et al.1. Briefly, a general population probability-based random sampling (GPRS) from all provinces was used to recruit respondents by telephone for the online survey. For this study, the sample was made using two approaches. A random digit dialing method (i.e. GPRS) for the general population across the country where the sample was drawn at random by province in proportion to their national size, and by First Nations and remote area zip codes to oversample those specific groups. Non-responders who did not complete the survey received a reminder message 3 and 6 days after the first recruitment. Of the 22,892 potentially eligible participants, 11,492 were recruited for the survey, for a recruitment rate of 50.6%. Of the 11,492 participants recruited, 6647 completed the online survey, representing an overall response rate of 29.0% among eligible respondents. To obtain a representative sample of rural, urban and suburban areas, the survey data was weighted with the most recent Statistics Canada census data. This also corrected for over- and under-sampled groups in certain geographic locations. There was no evidence of extreme values ​​in the weighted data that would indicate a sample bias. The margin of error for the study was ±1.2%, at a 95% confidence level (ie 19 times out of 20).

Determining Geographical Sample Regions

The sampling frame was set up to target respondents from remote/rural, suburban and urban areas in all ten Canadian provinces using the forward sortation area (FSA) zip code information.22. Respondents indicated the geographic region that best matched the area in which they lived based on population size. Because some zip codes can be either rural or urban, the geographic region in the statistical analysis was based on self-reported geographic region.

Questionnaire development, pre-testing and quality control

The questionnaire contained content to evaluate noise perception, nuisance and expectations of quiet, health-related and socio-demographic variables. The average duration of completing the online questionnaire was just under 10 minutes. The questionnaire was designed by Health Canada and pre-tested in both English and French. For the pre-test, 299 people were recruited by telephone (212 in English and 87 in French). This led to 72 completed online surveys (61 English and 11 French). Minor changes made to the survey after the pre-test did not affect the pre-test data, allowing the results collected during the pre-test to be incorporated into the final analysis. The English and French versions of the survey are available through Library and Archives Canada23.


In CPENS, participants were asked to indicate how they have been personally affected by the COVID-19 pandemic with regard to physical health, mental health, environmental noise nuisance, indoor noise nuisance, stress in their lives and general well-being. The response categories for these six outcome variables were as follows: much worse, slightly worse, unchanged, somewhat improved, and much improved. For modeling, the answers were grouped as: “somewhat/much worse” and “unchanged/slightly/much improved”. When reporting prevalence rates, responses were grouped into the following three categories: “slightly/much worse”, “unchanged” and “somewhat/much improved”. A number of other variables were collected in CPENS that were believed to be possibly related to the six results evaluated. These include the demographic variables such as age, gender, education, income and indigenous status. Age in years was divided into three groups (18–34, 35–54, 55+). The following gender categories were defined (female, male, other/prefer not to say). Education was rated as: up to high school diploma or equivalent, certificate or diploma, bachelor’s degree or postgraduate diploma. A certificate or diploma may come from a registered apprenticeship, or other profession, college, CEGEP (ie Quebec College) or other non-university, university below the undergraduate level. Total household income in Canadian dollars was grouped as follows: below $40K, $40K to just below $80K, $80K to just below $150K, $150K and above. Indigenous status was grouped as follows: Self-identification as First Nation/Métis/Inuk (Inuit), or Self-identification not. Residence and geographic region were also considered as possible predictors, as response to the pandemic varied by province and geographic region. Due to the smaller sample size, the prairie provinces (i.e. Manitoba and Saskatchewan) were grouped together, as were the Atlantic provinces (i.e. New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland & Labrador). The remaining provinces (British Columbia, Alberta, Ontario and Quebec) were classified independently. Self-reported geographic region was defined as rural/remote (ie <1,000 to 10,000 inhabitants), suburban (ie mixed-use or residential area, existing as part of a city or urban area, or as a distinct residential community within commuting distance of a city) and urban (ie 10,000+ inhabitants).

A respondent’s current work or school situation was also considered. Respondents identified themselves as: working outside the home or going to school; work from home or go to school; retired; unemployed; and some of those that indicate “other” can be grouped together as on paid leave (ie illness, maternity and disability). More than one option could be selected; therefore each situation was considered individually as a “Yes/No” answer.

Other variables considered included sleep disturbance (for any reason at home in the past 12 months), classified as highly disturbed by sleep (score 8 to 10) versus not very disturbed by sleep (score 0 to 7) . Similarly, sensitivity to noise was defined as very sensitive to noise (score 8 to 10) versus not very sensitive to noise (score 0 to 7). The participants were asked to rate their overall physical health relative to someone their age and their overall mental health (no reference to age). The answers to both questions were: bad; honestly; good; very good; and excellent. These were collapsed as: poor/fair and good/very good/excellent. Heart conditions, including high blood pressure, anxiety or depression, sleep disturbances and hearing loss were also rated as diagnosed by a healthcare professional, undiagnosed but suffering from the condition, or not applicable. Confirming a diagnosis was believed to indicate that the condition was current, and not one that existed historically, but was no longer current.

statistical methodology

Weighted frequencies and crosstabs were used to examine the distribution of demographics and population characteristics by indigenous status and geographic region. Cross-tabbling of each of the health-related outcomes and noise pollution variables affected by the pandemic, with indigenous status and geographic region were also considered. Chi-square tests of independence compared Indigenous status with non-Indigenous respondents, as well as geographic regions.

Initial univariate logistic regression models were used to examine the relationship between each of the health-related outcomes, including noise nuisance variables and other variables of interest, as mentioned above. Unadjusted odds ratios (ORs) are reported for each relationship in Supplementary Material (see Table S1). Finally, a multivariate logistic regression model was developed using stepwise regression techniques with a chi-square significance level for entering an effect into the model equal to 20% and the chi-square significance level for an effect to be included in the model. stay. of 5%. Adjusted ORs are reported for the final models for each evaluated outcome affected by the pandemic. Confidence intervals (CI) of OKs including the value 1 indicate insufficient evidence to observe a relationship between the evaluated result and the variable under investigation.

Statistical analysis was performed using SAS Enterprise Guide 7.15 (SAS Institute Inc., Cary, NC). A statistical significance level of 0.05 was used throughout unless otherwise noted. In addition, Bonferroni corrections were made to account for all pairwise comparisons to ensure that the total type I (false-positive) error rate was less than 0.05. Estimates with a coefficient of variation (CV) between 16.6 and 33.3% were designated “E” and should be interpreted with caution due to the high sample variability associated with them; CV estimates that were greater than 33.3% were labeled “F”, indicating that these data could not be released due to questionable validity. No results are reported for cell frequencies below 10.

This study has been approved by the Health Canada and Public Health Agency of Canada Review Ethics Board (Protocol No. REB 2020-038H). Informed consent is implied in the voluntary response to the survey questionnaire. This survey was conducted in accordance with all relevant Canadian government guidelines and regulations for conducting online surveys.

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