So, What s In Your House? Strategies for Measuring the Home Food Environment

Transcription

1 So, What s In Your House? Strategies for Measuring the Home Food Environment Dianne S. Ward Department of Nutrition Gillings School of Global Public Health University of North Carolina

2 AICR s 2013 Annual Research Conference on Food, Nutrition, Physical Activity and Cancer November 7-8, 2913 Hyatt Regency Bethesda Name of Speaker: Dianne Ward No Relevant Financial Relationship: None Relevant Financial Relationship: Name of conflicting business, organization or individuals: Nature of Conflict:

3 Talk Outline Define the home food environment (HFE) Explain why HFE is important Overview HFE assessment methods: Open food inventories (including scanning) Check list Food receipts Introduce a new measure (HomeSTEAD) Discuss policy implications based on HFE research

4 What s in the Neighborhood? Slide credit: Jr.League Greater Orlando

5 WHAT'S IN THE HOME?

6 Home Food Environment Physical Social All foods within the home Availability: food type, variety, quantity Accessibility: location, ease of obtaining Eating areas: Available spaces to eat (e.g., dining tables, breakfast bar) Characteristics of those spaces: clutter, table access, accommodations, amenities Sizes of plates, dishes, cups Food preparation spaces Kitchen equipment Food rules Open or closed access Feeding practices TV off or on Eating location (dining table, TV trays) Family meal patterns Eat meals together or individually Social influences Role modeling Prompting Controlling Rewarding/bribing

7 Do Foods in the Home Matter?

8 The Home Food Environment: May predict food intake Be associated with healthful (or unhealthful) diets Reveal factors associated disease outcomes (e.g., cancer, heart disease, obesity) Help identify intervention targets (availability, accessibility, variety, meal patterns, etc.)

9 MEASURING THE HOME FOOD ENVIRONMENT

10 What to Measure? All foods in the home Selected foods in the home Household food purchasing behavior Meals purchased away from home Other physical or social characteristics of the home food environment

11 Common Methods Used Open food inventories (+scanning) Home food checklists Food receipts

12 Open Inventory Where do people store food? Kitchen Refrigerator Freezer Cabinets Pantry Storage room Dining Room Garage Porch Other?

13 Open Inventory Method Assessment of all foods in the home, or all foods within a category Usually conducted by research staff Item is noted as present/absent or by amount & type Frequently data are analyzed with dietary assessment software (e.g., NDSR) Get total household value of foods available (e.g., servings per adult + child)

14 Open Inventory Studies Author Focus Finding Coates el al., 1978 Child obesity (65 families) Bryant et al., 2008 Child obesity (85 families) Laska & Story, 2011 Dormitory rooms (100 students) Fathers junk food, desserts positive assoc. with weight; neg. with lowcalorie foods Availability of vegetables was related to vegetable intake in 3-8 y olds Items ranged from 0-208; Avg. kcals/dorm room = 22,888; sign. assoc. of kcals with SSB intake

15 Open Inventory Studies: UPC Scanner Author Focus Finding Byrd-Bredbenner et al.*, 2009 Stevens et al., 2009 Nutrients in food (100 families with at least 1 child <12 y) Child obesity (80 low-income AA mothers) Most kcals, CHO, dietary fiber, tot. sugar, sodium, iron - from grains; Most fat, cholesterol, and protein from meat/protein. Dairy products - greatest quantities of saturated fat and calcium. Exhaustive home food inventory scanning UPC codes; linked codes to food identities and energy values Found process to be feasible; was able to reduce time required to about 100 min.

16 Use of Open Inventories Benefits Potential to evaluate all food/beverages Can calculate household kcals Scanner technology can improve approach Scanner can link to available UPC codes Limitations Labor-intensive Intrusive to families Usually requires dietary analysis for summary information Protocols needed for quantification Access to more UPC codes is costly

17 FOOD CHECK LISTS

18 Checklists Checklists range between a low of 10 items to more than 200 Lists of foods depend upon study aim Checklist used by multiple studies: 5-A-Day studies Home Fruit & Vegetable Availability Survey (Project Eat) Foods Reflecting Guidelines to Reduce Cancer (Crockett at al., 1992) Many check-lists used for single studies

19 Checklists Most rate foods present or absent; some record food quantities May use likert-type scale (e.g., always, sometimes, never) Usually self-administered; more extensive checklists my be conducted by researcher visit or interview Usually summarized by food group (e.g., fruit/veggies, high-fat foods)

20 Check-Lists Examples Study Focus Findings Crockett et al., 1992 Miller & Edwards, 2002 Hanson et al., 2005, Hearn et al item checklist to assess assoc. home foods with cancer recommendation Expanded (+86 items) for use with elderly diabetics Adolescent obesity (902 adolescents & family) FV checklist (22 item) for the 5-A-Day project Validation conducted with good sensitivity & specificity values Criterion validity was strong For girls, household availability assoc. with FV intake (trend =2.70, p <0.01) and soft drink availability inversely associated with dairy intake (trend =2.08, p < 0.04). For boys, milk at meals was associated with dairy intake (trend =3.65, p < 0.01). Moderate reliability; Reynolds (1999) & Kratt (2000) increased items to 34 and improved list; High- and low-fat foods added (Cullen 2004, GEMS)

21 HFE Assessment for Food Insecure Mexicano Residents Sharkey used 252-item inventory (pretested for cultural and linguistic appropriateness) to assess food availability Data collected by 2 promotora researchers on 5 separate occasions over 30-d in a small sample of Mexicano women Demonstrated the need for multiple observations Sisk, Sharkey et al., Nutrition Journal, 2010 Sharkey et al., Int.J.Beh.Nutr PA, 2010

22 Photos from Dr. Joe Sharkey

23 Fresh Fruit: Variety Fruit Time All 5 4/5 3/5 2/5 1/5 0/ %* 17% 0 17% 17% 33% 17% 1 33% 0 67% % 2 17% % 50% 33% % 83% Bananas were most freq. observed but varied per visit/household Apples & oranges never observed Similar findings (variability) in FV, dairy, meat/fish/poultry, grains/snacks/deserts, beverages Illustrates the need for multiple samples of food availability *% of households with different varieties of fruit

24 Fresh Fruit: Variety Fruit Time All 5 4/5 3/5 2/5 1/5 0/ %* 17% 0 17% 17% 33% 17% 1 33% % % 2 17% % 50% 33% % 83% Bananas were most freq. observed but varied per visit/household Apples & oranges never observed Similar findings (variability) in FV, dairy, meat/fish/poultry, grains/snacks/deserts, beverages Illustrates the need for multiple samples of food availability *% of households with different varieties of fruit

25 Checklist Summary Benefits Limitations Feasible to administer Depending upon length, may have limited burden Short & long options Can be tailored to particular disease issues (e.g., cancer, heart disease) Few measures have good psychometric properties Shorter lists may provide limited information Self-report could be result in biased information

26 HOME FOOD RECEIPTS

27 Use of Food Receipts What is a food receipt? Grocery store receipt Meal (eaten in or take-away) Convenience store Coffee bar Snack bar Other locations

28 Food Receipt Methods Requires collection and annotation Primary shopper must coordinate among family members (ask about food purchases) Annotation requires info. on item, quantities, cost & source From all sources

29 Food Receipts Example: Take Action Study Used household food receipts as part of a household-obesity study Collected & annotated household food receipts for 4 wks before/after intervention Receipt data showed significant decrease in HH/person $ spent eating out; no change for foods in home Concluded 2 wk. adequate French et al., Obesity, 2011

30 Food Receipt Method Benefits Could capture total HFE environment (home foods & meals purchased outside home) Meals outside of home may be important focus Limitations Requires motivated family participant who collects & annotates records Labor intensive and risk for data loss Additional analyses required following after collection

31 HOMESTEADTOOL Home Self-administered Tool for Environmental assessment of Activity and Diet DS Ward, A Vaughn, D. Hales, M Bryant, R Tabak, J Stevens R21CA134986

32 What is HomeSTEAD Tool? Goal: To develop comprehensive, selfreport measure of the home environment specifically related to obesity Based on prior work with Healthy Home Survey (Bryant et al., Int. J. Beh. Nutr. PA, 2008) Measures both physical and social environments (food & physical activity) For this talk, will describe work to date on measurement of food physical environment

33 Frozen treats Fruits and vegetables Fresh Frozen Canned/jarred Dried Grains S P Potatoes Snack foods Chips Crackers Cookies Cakes Candy HFE Fresh Frozen Canned Dairy Beverages Beans Dried Canned Frozen Milk Yogurt Cheese

34 Reliability and validity testing Complete 1 st survey (Time 1) 2-3 days In-home observation Collect parent and child anthropometrics and child diet/pa 1-2 days Complete 2 nd survey (Time 2) days Complete 3 rd survey (Time 3) N=129 families with 1 child 3-12 years old

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36 Reliability and Validity - 1 S P Ounces of food/beverage ICC 20 0 Frozen fruit Canned vegetables Self-report Canned beans Crackers Cheese Time 1 Time 2 Time 3 Observation

37 Reliability and Validity - 1 S P Ounces of food/beverage Correlation 20 0 Frozen fruit Canned vegetables Self-report Canned beans Crackers Cheese Time 1 Time 2 Time 3 Observation

38 Reliability and Validity - 2 S P Ounces of food/beverage ICC 20 0 Chips Cookies Cakes Candy Time 1 Time 2 Time 3 Observation Self-report

39 Reliability and Validity - 2 S P Ounces of food/beverage Correlation 20 0 Chips Cookies Cakes Candy Time 1 Time 2 Time 3 Observation Self-report

40 Reliability and Validity - 3 S P Ounces of food/beverage ICC Grains SSBs Time 1 Time 2 Time 3 Observation Self-report

41 Reliability and Validity - 3 S P Ounces of food/beverage Correlation Grains SSBs Time 1 Time 2 Time 3 Observation Self-report

42 Preliminary Analysis: Snack Foods More crackers, cookies, and greater variety of sweet snacks in homes with overweight parents. Also, more sodas and sweetened beverages. Trend for overweight parents to have more frozen treats (e.g., ice cream, frozen yogurt, popsicles). Households with overweight children had fewer frozen treats compared to those with normal weight children, and a trend toward less ice cream.

43 Preliminary Data: Vegetables More fresh vegetables in homes of white families with normal weight children compared to white households with overweight children (41 vs. 24 servings, p<0.05), after adjustment for age, gender, income, household size and shopping habits In households with black children, smaller difference were observed between overweight and normal weight children, and in the reverse direction (25 vs. 28 servings). Similar trend toward for fresh fruits, but NS

44 HomeSTEAD: Next Steps Goal: create a comprehensive, self-report measure of the home food/physical activity environment First phase completed: Physical Activity Physical Environment (Hales et al. In review) Food (physical & social) and PA (social) in development Implementation with wide range of families compared to diet & PA behaviors

45 Policy Implications Insufficient data from HFE studies currently preclude policy recommendations. However, studies of the home food environment and diet could add to the policy debate Amounts or type of benefit (e.g., SNAP benefits, WIC) Types of foods offered by food banks

46 Should SSB purchases be restricted on SNAP benefits? 2004 & 2011 requests by MN & NYC for pilot programs to test limiting SSB from SNAP was denied Hunger agencies feel differently June, 2013: AMA & 18 city mayors asked SSB limit

47 Conclusion HFE is an important contributor to food intake in children and adults Measurement strategies range from simple (10-item check list) to difficult (exhaustive, open inventory) More research is needed, especially in looking at the interaction of the physical and social environments HFE research could identify intervention targets and add to the policy debates