Information for Professionals

The Ottawa Student Drug Use and Health Report 2014 offers a snapshot of health risk behaviours among youth in Ottawa using data from the Ontario Student Drug Use and Health Survey (OSDUHS).

Full report [PDF 875 KB]
Infographics:

• Alcohol Consumption [ PDF 5.36 MB ]
• Drug Use [ PDF 1.24 MB ]
• Healthy Eating, Active Living, Body Image [ PDF 151.74 KB ]
• Gambling [ PDF 508.76 KB ]
• Mental Health [ PDF 159.01 KB ]
• Tobacco Use [ PDF 1.03 MB ]

Substance Misuse in Ottawa Report [PDF 887 KB.]

In Ottawa:

• Unintentional opioid drug overdose emergency department visits exceed overdoses from all other drugs combined (e.g., cocaine, barbiturates and amphetamines). Opioid overdoses have increased markedly since 2015 (Figure 3).
• Young adults have the highest rates of unintentional opioid overdose emergency department visits, peaking in the 30 to 34 year age group (Figure 4).

Figure 3. Emergency department visits for unintentional opioid and non-opioid drug related overdoses in Ottawa from 2008 to 2017

Figure 4. Emergency department visit rates (counts per 100,000 population) for unintentional opioid overdose by age group in Ottawa, 2017 

• A different pattern is seen when looking at drug-related emergency department visits for mental and behavioural disorders in Ottawa (Figure 5, Table 6). Non-opioid related mental and behavioural disorder emergency department visits exceed those of opioids and show an increasing trend beginning in 2015 (Figure 5). 

Figure 5. Emergency department drug-related mental and behavioural disorder visits in Ottawa from 2008 to 2017

In Ottawa:

• Unintentional opioid drug overdose hospitalizations exceeded overdoses from all other drugs combined (e.g., cocaine, barbiturates, amphetamines) (Figure 6).
• Adults aged 65 and older have the highest rates of unintentional opioid overdose hospitalizations (Figure 7).  This group also has the highest rate of opioid prescription for pain (Figure 8).

Figure 6. Hospitalizations for unintentional drug related overdoses in Ottawa from 2008 to 2017

Figure 7. Hospitalization rates (counts per 100,000 population) for unintentional opioid overdose by age group in Ottawa, 2017

Figure 8. Prescription rates as counts per 1,000 population for opioid prescriptions for pain by age group in Ottawa, 2017

• Although non-opioid mental health and behavioural hospitalizations exceed those that are opioid-related, this difference has narrowed in recent years (Figure 9).
• Table 11 shows the mental and behavioural disorder hospitalizations by drug type.

Figure 9. Opioid and non-opioid related mental and behavioural disorder hospitalizations in Ottawa from 2008 to 2017

Unintentional Drug Overdose Deaths

• In 2016, there were 45 deaths associated with unintentional drug overdoses, including overdoses where intent was unknown. The majority of these deaths (37, 82%) were opioid related (Figure 10).
• Figure 11 shows the age distribution of unintentional drug overdose deaths in Ottawa in 2016.
• The rate of drug overdose deaths increased 32% in Ottawa between 2014 and 2015 and only 6% in the rest of Ontario (Figure 12). The increase in unintentional overdose deaths in Ottawa and the rest of Ontario has been due to increased unintentional opioid overdose deaths (Figure 12).
• Since 2014, fentanyl has been involved in the largest proportion of drug overdose deaths in Ottawa. For more information see the "Drug-related death in Ottawa, 2000-2015" report. 

Figure 10. Unintentional drug overdose deaths in Ottawa by type of drug involved, 2016

Figure 11. Age distribution of unintentional drug overdose deaths in Ottawa, 2016 (45 deaths total)

Opioid-Related Overdose Deaths

Total opioid overdose deaths include those that are unintentional, intentional (suicide) or of unknown intent.

• There were a total of 64 opioid overdose deaths in 2017, an increase from 40 opioid overdose deaths in 2016 (Figure 12). The increase in opioid-related deaths is consistent with the trend seen in emergency room visits and hospitalizations: opioid-related harms have been increasing over the past few years (Figure 12).
• The mortality rate resulting from opioid use was highest in the 45 to 64 year old age group in 2017 (Figure 13).
• Fentanyl was the single most common opioid implicated in unintentional opioid-related overdose deaths in 2016 (Figure 10). In 2017, fentanyl was responsible for 72% of all-intent opioid related deaths (46 of 64). [4]

Figure 12. Total opioid overdose deaths in Ottawa and rates per 100,000 population, 2008 to 2017

Figure 13. Total opioid overdose related deaths by age group and rates as counts per 100,000 population in Ottawa, 2017

• July 2017 report (PDF) [369 KB]
• June 2017 report (PDF) [279 KB]
• May 2017 report (PDF) [240 KB]
• April 2017 report (PDF) [283 KB]

This report focuses on the prevalence of use, and the associated morbidity and mortality from the problematic use of illicit drugs, excluding cannabis, and of opioid prescription drugs used for non-medical purposes.

Problematic Substance Use in Ottawa - Technical Report [PDF 2.5 MB]

This report provides epidemiologic information about the risk of overdose and HIV and HCV infection among people who use drugs.

Overdose and HIV and hepatitis C infection among people in Ottawa who use drugs - 2014 [PDF 369 KB]

1.  Ottawa Public Health. Canadian Community Health Survey 2015/16. Ontario Share File. Statistics Canada.
2. Ottawa Public Health. Public Health Monitoring of Risk Factors in Ontario – Ontario Student Drug Use and Health Survey 2017. Centre for Addictions and Mental Health
3. Office of the Chief Coroner for Ontario. [Extracted April 2018]
4. Ontario Agency for Health Protection and Promotion (Public Health Ontario). Interactive Opioid Tool. Toronto, ON: Queen’s Printer for Ontario; 2018. Available from: http://www.publichealthontario.ca/en/DataAndAnalytics/Opioids/Opioids.aspx

Youth Alcohol Consumption

First Use of Alcohol

• Among Grade 9 to 12 Ottawa students in 2017, 23% reported using alcohol before Grade 9. [6]

Harmful Drinking Behaviour

• In 2017, almost one in six (15%*) Grade 9 to 12 students in Ottawa reported getting drunk (i.e., had so much to drink that they could not do what they wanted to do or threw up) in the past four weeks. [6]
• In 2017, one in ten (10%*) Grade 9 to 12 students in Ottawa reported drinking at a hazardous or harmful level, as determined by the AUDIT screen. [6]
• Among Grade 9 to 12 students in Ottawa that had consumed alcohol in the past year, one in five (20%*) reported drinking at hazardous or harmful levels. [6]

Alcohol and Cannabis Co-use

• In 2017, 18%* of Grade 9 to 12 students in Ottawa reported using alcohol and cannabis at the same time in the past year. [6]

Status of Alcohol in Ottawa: Let's Continue the Conversation, 2016

This report blends local epidemiological data on drinking and alcohol-related harms with local perspectives from the 2016 online "Have Your Say" alcohol survey in order to provide a complete picture of how alcohol affects our community.

Status of Alcohol in Ottawa: Let's Continue the Conversation, 2016 [PDF 7.7 MB]

References - Historical Data on Alcohol Use

1. Ottawa Public Health. Problematic Substance Use in Ottawa: Technical Report. Ottawa, Ontario; 2016.

2. Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet. 2009;373(9682):2223-33.

3. World Health Organization. Global status report on alcohol and health 2014. Geneva; 2014.

4. Ottawa Public Health. Canadian Community Health Survey Ontario Share File 2015-2016. Statistics Canada. 

5. Ottawa Public Health. Status of Alcohol in Ottawa: Let's Continue the Conversation. Ottawa, Ontario; 2016.

6. Ottawa Public Health. Public Health Monitoring of Risk Factors in Ontario – Ontario Student Druge Use and Health Survey (2017), Centre for Addictions and Mental Health.

7. Public Health Agency of Canada. The Chief Health Officer's Report on the State of Public Health in Canada 2015. Alcohol Consumption in Canada. Ottawa, Ontario 2016.

8. Butt P, Beirness, G, Gliksman, L, Paradis, C, Stockwell, T. Alcohol and health in Canada: A summary of evidence and guidelines for low-risk drinking. An independent report prepared for the National Alcohol Strategy Advisory Committee and the Canadian Centre for Substance Abuse, Ottawa, Canada. 2010.

9. Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: a global public-health challenge. Lancet. 2007;369(9569):1302-13.

Cannabis use among Ottawa adults

Cannabis use for adults includes those who have used cannabis in the past 12 months while excluding those who have only used it once in their lifetime.

• in 2015-16, cannabis use in Ottawa among those 19 years of age or older was slightly higher than the provincial average: 15% compared to 11%. [1]
  
• Cannabis use was highest among men (20%) and young adults age 19 to 24 (33%) and those with a high school education as their highest educational attainment (25%) (Figure 1).
• Ottawa residents with a mother tongue other than French or English had lower rates of cannabis use (5%). [1]

Figure 1. Cannabis use in Ottawa by subgroup (19 years of age or older), with the exception of the 12 to 18 age group, 2015-2016. 

• In 2017, 18% of Ottawa students in Grades 7 to 12 reported using cannabis in the past year, which is similar to students in the rest of Ontario (19%). Use in the past year use has not significantly changed in Ottawa since 2009. [2]
• Among students who’ve used cannabis: [2]
  • one-quarter (27%) first tried it before Grade 9,
  • half (50%) first tried it in Grade 9 or 10, and
  • one in five (21%) first tried it in Grade 11 or 12.
• Just over 1/3 of Ottawa students in Grades 7 to 12 (34%) felt that getting cannabis would be easy or fairly easy. [2]

• Approximately 14% of adults who have not used cannabis in the past year are at least moderately likely to try cannabis post-legalization. [3]
• Once legalized, 13% of Grade 9 to 12 students in Ottawa reported they would try cannabis. An additional 19% of Grade 9 to 12 students reported they would use it as often or more often than they currently do. [2]

There are some harms associated with cannabis use.

• The annual number and rate (per 100,000 population) of emergency department (ED) visits directly related to cannabis use has increased from 2008 to 2017 (Figure 2). 
• Over 93% of cannabis-related ED visits are for mental and behavioural disorders. The frequency of cannabis-related mental and behavioural disorders by type of disorder are shown in Table 3.
• These statistics do not represent the full health burden of cannabis. Harms secondary to cannabis use, such as injuries resulting from a car crash where the driver was impaired by cannabis can’t be identified from existing data.

Figure 2. Annual number of cannabis-related emergency department (ED) visits and rate as ED visits per 100,000 population for Ottawa residents from 2008 to 2017

How are people using cannabis?

• Ottawa level data on methods and practices is not currently available
• Canadian data shows the main methods of consumption were [5]:
  • smoking (94%),
  • eating in food (34%),
  • vaporizing using a vape pen (20%), and
  • vaporizing using a vaporizer (14%).

People's perception of smoking or using edible cannabis

• In Ottawa, 63% of those who had used cannabis in the past 12 months thought that the effects are felt more quickly when cannabis is smoked as compared to eaten (63%). This drops to 43% among those who have used cannabis in the past but haven’t used it in the past 12 months. Over half of those who have never used cannabis (58%) were not sure. [3]

• In Ottawa, 84% of those who had used cannabis in the past 12 months thought that smoking cigarettes was more harmful than smoking cannabis (84%). Those who used before but not in the past year were less likely to think this (62%) as were those who have never used (42%). [3]

Cannabis and potency

• There is no population health data about how people choose cannabis products or how things like potency may influence choices. The source people choose (e.g. home grown, retail cannabis) may be important for potency considerations. 

Cannabis availability and access

• Just over one-third (34%) of Ottawa students in Grades 7 to 12 think cannabis would be fairly easy or very easy to get if they wanted some. [2]
• Perceived ease of availability increased with increasing age: 14%* of Grade 7 to 8 students, 30% of Grade 9 to 10 students, and 63% of Grade 11 to 12 students think cannabis would be fairly easy or very easy to get. [2]
• Almost half (44%) of Grade 7 to 12 students who used cannabis in the past year reported that it was given to or shared with them by a friend, sibling or parent. [2]
• Canadian data shows that about 36% adults tend to get cannabis from friend or family. [5]

*Interpret with caution due to high sampling variability

Frequency and intensity of cannabis use

Frequent (i.e., daily or near daily) use can increase the likelihood of negative health effects, particularly mental health problems, dependence, and changes to brain growth and development prior to 25 years of age.

• Just over a third of Ottawa residents (36%) who used cannabis in the past year report using it weekly or more, 19% use it between 1 to 3 times a month and 44% report using it less than once a month. [1]
• Among Grade 9-12 students, 11% report using cannabis more than 10 times in the 12 months prior to the survey. [2]

Cannabis and driving

• The risk of accident involvement and driving-related injuries or death is two to three times higher among cannabis-impaired compared with non-impaired drivers. The risk is even higher if cannabis and alcohol are used together. [6]
• One in ten Grade 7 to 12 students (11%) have ridden in a vehicle at least once in the past year when the driver had been using drugs. [2]
• In Canada, 14% of cannabis users with a valid driver's license said they had driven within two hours of use. This increases to 23% for drivers who used cannabis daily or weekly. [5] 
• In Ottawa, 84% of those who used cannabis in the past year felt that cannabis use impairs one’s ability to operate a motor vehicle. [3]

Special risk populations 

References for Historical Cannabis Use Data

1. Canadian Community Health Survey 2015-2016, Statistics Canada, Share File, Ontario MOHLTC.
2. Ottawa Public Health. Public Health Monitoring of Risk Factors in Ontario-OSDUHS (2017). Centre for Addiction and Mental Health; 2018.Survey of Ottawa Residents of Health Risks of Cannabis. EKOS Research Associates Inc. January 4, 2018
3. Survey of Ottawa Residents of Health Risks of Cannabis. EKOS Research Associates Inc. January 4, 2018
4. National Ambulatory Care Reporting System 2008-2017, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date Extracted: Aug 2018
5. The Canadian Cannabis Survey. Health Canada 2017. Summary available from:  https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/canadian-cannabis-survey-2017-summary.html
6. Fischer, B., Russell, C., Sabioni, P., van den Brink, W., Le Foll, B., Hall, W., Rehm, J. & Room, R. (2017). Lower-Risk Cannabis Use Guidelines (LRCUG): An evidence-based update. American Journal of Public Health, 107(8). DOI: 10.2105/AJPH.2017.303818
7. Metz TD, Borgelt LM. Marijuana Use in Pregnancy and While Breastfeeding. Obstet Gynecol. 2018 Sep 18. [Epub ahead of print]

Adult Smoking

Current Smoking Trends Over Time

Current smoking includes those aged 19 and older that have used at least 100 cigarettes in their lifetime and currently smoke tobacco.

• In 2015-2016, 15% of Ottawa residents aged 19 and older were current smokers. This estimate was significantly lower than Ontario-less-Ottawa (17%). [1]
• Current smoking rates in Ottawa have declined since the early 2000’s (Figure 1).

Figure 1. Percentage of current smokers aged 19 years and older in Ottawa and Ontario-less-Ottawa, from 2001 to 2016 

Current Smoking Trends by Socio-demographics

• In Ottawa, current smoking prevalence is higher among those (Figure 2):
• between the ages of 19 and 24 (18%*);
• with French as a mother tongue (20%*);
• with lower levels of education (22%*); and
• with lower income (26%*).

Figure 2. Percentage of current smokers aged 19 years and older by selected socio-demographic indicators in Ottawa in 2015/16. Only the 12 to 18 year age group includes those under 19 years of age. 

Daily Smoking Trends Over Time

• An estimated 10% of the Ottawa population aged 19 and over smoke tobacco daily. Daily smoking rates in Ottawa and Ontario-less-Ottawa have decreased since the early 2000’s (Figure 3).
• Daily smoking is highest among those in the lowest income category and among those without post-secondary education (Figure 4).

Figure 3. Percentage of daily smokers aged 19 years and older in Ottawa and Ontario-less-Ottawa, from 2001 to 2016

Daily Smoking by Socio-demographics

 Figure 4. Percentage of daily smokers aged 19 years and older by selected socio-demographic indicators in Ottawa in 2015/16. Only the 12 to 18 year age group includes those under 19 years of age.

Youth Smoking

This section describes cigarette use and access to tobacco among youth in Ottawa.

Use of cigarettes

• Among Grade 7 to 12 students [2]:
  • 6% reported smoking one or more cigarette in the past year;
  • 4% were former smokers;
  • 4% had tried a few puffs to one whole cigarette in the past year; and
  • 87% had never smoked.
• Elementary students (Grades 7 and 8) were significantly more likely to report having never used cigarettes in the past year (97%) compared to students in high school (83%). [2]

Ease of acquiring cigarettes

Students in Grades 7 to 12 were asked how easy they felt it would be to get cigarettes if they wanted them.

• 43% percent of students reported that they felt it would be very to fairly easy to get cigarettes. An additional 29% reported that it would be fairly difficult to impossible and 27% did not know. [2]
• High school students (Grades 9 to 12) (53%) were more likely than elementary students (Grades 7 to 8) (26%) to say that it would be very to fairly easy to get cigarettes. [2]
• Students who identified as immigrants were less likely to feel that it would be easy to get cigarettes compared (30%) to non-immigrant students (48%). [2]

Exposure to Environmental Tobacco Smoke

Public Places

• In Ottawa, 15% of the population aged 12 years and older who are not daily smokers reported regular exposure to environmental tobacco smoke (ETS) in public places. This estimate is not significantly different from Ontario-less-Ottawa (16%). [1]

Workplaces and Schools

• In Ottawa, 15% of the population aged 12 years and older who are not daily smokers reported regular exposure to ETS at work or school. This is not significantly different from Ontario-less-Ottawa (16%). [1]
• 14% of Ottawa students in Grades 7 to 12 are regularly (4 or more days a week) exposed to other people’s tobacco smoke. [2]
  • Students in Grades 9 to 12 (17%) were more likely than students in Grades 7 and 8 (9%) to be exposed to seconhand smoke. [2]

Vehicles

• 3% of the Ottawa population aged 12 years and up who are not daily smokers reported being regularly exposed to ETS in vehicles. [1]

Smoke-free Homes

• In Ottawa, 92% of homes are completely smoke free. This is higher than Ontario-less-Ottawa for which 90% of homes are completely smoke free. [1]

Health Burden of Smoking

• Smoking is responsible for an estimated 916 deaths per year in Ottawa.
  • 866 deaths (17% of deaths from any cause) are attributable to current or former cigarette smoking among adults aged 35 years and older and
  • 50 deaths (1% of deaths from any cause) are attributable to environmental tobacco smoke (ETS) exposure in residents aged 15 years and older. 
  • Cancer accounts for 50% of smoking-attributable mortality (SAM) among current or former smokers, while cardiovascular disease accounts for 29% of SAM, and respiratory disease accounts for 21% of SAM.
• There are an estimated 3,020 acute hospitalizations per year in Ottawa attributable to smoking.
  • 2,942 hospitalizations are attributable to current or former cigarette smoking
  • 118 hospitalizations are attributable to environmental tobacco smoke exposure among residents.
• Hospitalization costs amounted to an average of $32.7 million per year for smoking-attributable hospitalizations of Ottawa residents from 2008 to 2012.
  • $31.1 million for current or former smokers
  • $1.6 million for non-smokers regularly exposed to ETS.

Waterpipe Use Among Adults

Waterpipe Used at Least Once - Adults (18 years and older)

• In 2017, 26% of adults in Ottawa had used a waterpipe at some point in their life to smoke tobacco or non-tobacco herbal products. [7] Waterpipe use at least once in a lifetime was highest among men and those aged 18 to 24 years (Figure 5).
• Among Ottawa adults that had used a waterpipe in their lifetime [7]:
  • 38% had used tobacco only;
  • 36% had used herbal products only; and
  • 26% had used both tobacco and herbal products.

• In 2017, 4%* of adults in Ottawa that had never used a waterpipe reported having seriously thought about smoking a waterpipe. [7]

Figure 5. Percentage of adults aged 18 years and older who used a waterpipe at least once in their lifetime by selected socio-demographic indicators in Ottawa in 2017. 

Waterpipe Use in the Past 12 months – Adults (18 years and older)

• In 2017, 6%* of Ottawa adults had used a waterpipe in the past 12 months to smoke tobacco or non-tobacco herbal products. [7] This is not different than the estimate for Ontario (including Ottawa). [8] 
• Use is highest among young adults aged 18 to 24 at 28%. [7]
• Ottawa adults reported using a waterpipe in the past 12 months at the following locations (no other locations are reportable due to high sampling variability)[7]:
  • restaurant, bar, or club (43%*);
  • at home (41%*); and
  • someone else’s home (35%*).
• Of Ottawa adults that had used a waterpipe in the past 12 months, 78% used the waterpipe once a month or less and 22%* used the waterpipe more than once a month. [7]
• Of those who have used a waterpipe in the past 12 months, 58%* always or sometimes shared a mouthpiece. [7]

Waterpipe Use Among Youth

Waterpipe Use at Least Once – Youth (Grades 7 to 12)

• In 2017, 14%* of grade 7 to 12 students in Ottawa had used a waterpipe at some point in their life. [2] This is not different from Ontario-less-Ottawa.

Waterpipe Use in the Past 12 Months – Youth (Grades 7 to 12)

• In 2017, 9%* of grade 7 to 12 students in Ottawa had used a waterpipe in the past 12 months. [2] This is not different from Ontario-less-Ottawa.
• Of grade 7 to 12 students in Ottawa that had used a waterpipe in the past 12 months, 7%* had experimented (i.e., used a few times or less) while 5%* were current users (i.e., at least once a month). [2]

Perception of Risk and Waterpipe Use – Youth (Grades 7 to 12)

• The percent of Grade 7 to 12 students that felt smoking a waterpipe presented a physical risk to the user by risk level [2] was:
  • 43% medium to high risk to user;
  • 23% no or slight risk to user; and
  • 32% unsure of risk to user. 

Adult E-cigarette use

• E-cigarette use in Ottawa among those aged 19 and over is 12% for use in their lifetime, 8%* for use in the past 12 months and 2%* for use in the past month. [7] This is not different from the Ontario population aged 18 and older (including Ottawa). [8]
• Just over half of those who used e-cigarettes in the past 12 months are current smokers (56%*). Of current smokers, 39% reported using an e-cigarette in the past 12 months. [7]

Motives for use

• Of those who used an e-cigarette in their lifetime, most of their use appears to be related to smoking cessation [7]:
• 42% used e-cigarettes to help quit smoking,
• 13%* to try to cut back on the amount of cigarettes.
• In 2017, 12%* used e-cigarettes out of curiosity, down from 40% in 2016.

Beliefs about risk

• When asked about their beliefs about the risks of using e-cigarettes [7]:

• 66% of Ottawa residents aged 19 and over feel that it present a high to medium health risk;

• 15% feel that it presents low or no risk; and

• 19% are unsure of the risk

• Those that used an e-cigarette in the past 12 months were nearly three times as likely as non-users to say that e-cigarettes represented low or no risk (35% versus 13%). [7]

Youth and E-cigarettes

• One in ten (10.1%* (95% CI: 6.2% to 16.3%)) high school students (grade 7 to 12) had used an e-cigarette at least once in the past 12 months. [2] This is not different from Ontario-less-Ottawa.
• 48% of Grade 9-12 students felt that e-cigarettes present no or a slight risk of physical harm with regular use. [2]

A Review of Tobacco Indicators 2012

References

1. Ottawa Public Health. Canadian Community Health Survey 2015/16. Ontario Share File. Statistics Canada

2. Ottawa Public Health. Public Health Monitoring of Risk Factors in Ontario – Ontario Student Druge Use and Health Survey 2017. Centre for Addictions and Mental Health

3. Ottawa Public Health. Canadian Community Health Survey 2008 to 2012. Ontario Share File. Statistics Canada
4. Ontario Mortality Data 2008 to 2012, Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO, Date extracted: January 2017 
5. National Ambulatory Care Reporting System (NACRS) 2013 to 2015. Ontario Ministry of Health and Long-Term Care (MOHLTC): IntelliHEALTH ONTARIO, Date Extracted: January 2017 
6. Cobb C,Ward KD, Maziak W, Shihadeh,AL, Eissenberg T. Waterpipe Tobacco Smoking: An Emerging Health Crisis in the United States. American Journal of Health Behavior, Volume 34, Number 3, May 2010 , pp. 275-285(11)
7. Ottawa Public Health. Rapid Risk Factor Surveillance System, 2017.
8. Centre for Addiction and Mental Health Monitor (Full Year), 2016.