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Foodbook: Canadian Food Exposure Study to Strengthen Outbreak ResponseAndrea Nesbitt, MSc., Public Health Agency of Canada
Canadian Public Health Association, Toronto, OntarioMay 29, 2014
Foodbook• ‘Foodbook’ is a national population survey that will
estimate Canadians' exposure to foods over a seven-day period, that may serve as vehicles of foodborne infections» Essential for timely and effective foodborne illness
outbreak response(e.g. 76% of outbreak cases report eating spinach, is this unusual or expected?)
• Conducted jointly by the Enteric Surveillance and Population Studies Division (ESPS) and the Outbreak Management Division (OMD), CFEZID in consultation with Federal / Provincial / Territorial (F/P/T) partners
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Background and Rationale• National food exposure data for outbreak response do
not exist» 7 year-old data from the US & one regional study in
Ontario» Nutrition focused surveys do not meet these data needs
• HC-PHAC Committee on Food Safety and Nutrition:» Need exists for current food exposure data across the
Health Portfolio» Collection of food & nutrient consumption data as an area
for collaboration• Proposed PHAC Food Safety Strategic Plan, Strategic
Priority #1:» Enhanced data for action
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Purpose Primary Objective:
» Enhance national public health capacity to identify and remove the source of foodborne illness outbreaks
Secondary Objectives:» Inform microbial risk assessments » Inform retail sampling components of Canadian integrated
enteric disease surveillance programs» Estimate the incidence and burden of acute gastrointestinal
illness in Canada » Examine relationships between eating patterns, obesity and
socioeconomic status» Inform development of targeted disease prevention and
control strategies with maximum impact including consumer messaging
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Methodology
• Population-based telephone survey• Food and other exposures in 7 day recall period• Subset with 3 day recall period• Land line (80%) and cell phone (20%) area sampling
frames• Sample size ~11,000• Sample distributed across:
» 12 calendar months» 4 age groups (0-9, 10-19, 20-64, 65+)» All provinces and territories
• Interviews conducted in English, French and Inuktitut; on-demand verbal translation offered for some other languages
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Methodology• Sampling strategy
» Area frame of addresses used to ensure sample within each P/T covers population of P/T by census sub-division
» Random selection of households and participants within household
» Weighting methods being developed to account for sampling methodology and ensure representative data
» Participants enrolled to ensure even distribution over 12 calendar months and specified age groups within each P/T
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Methodology• Inclusion criteria:
» Residents living at listed land line or cell telephone number in Canada
• Exclusion criteria: » No listed land line or cell telephone number; » Overnight travel outside P/T in past 7 days; » Unable to communicate in English, French or
Inuktitut or other languages covered by surveyors
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Interview Tool• Module 1: Food exposures & frequency (~200 questions)
» Infant foods, fruits, vegetables, prepared salads & dips, herbs, nuts, seeds, meat (beef, pork, poultry, deli, other), seafood, eggs, dairy/dairy substitutes, frozen prepared foods, dried/processed foods, ethnic foods, fast food restaurants, country foods (territories only)
• Module 2: Drinking & recreational water exposures (~10 questions)
• Module 3: Animal-related exposures (~10 questions)
• Module 4: Food safety knowledge & practices (~10 questions)
• Module 5: Acute gastrointestinal illness (~15 questions)
• Demographics & other personal information» age, sex, income, education, self-reported height and
weight
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Outputs• Published reports summarizing:
• Food exposure and demographic data• Water & animal exposure data• Consumer food safety practice data• Incidence & burden of acute gastrointestinal illness in
Canada• Key findings specific to the territories • Comparison of 3-day vs. 7-day recall period
• National dataset of food, water & animal exposure data, & consumer food safety practice data for PHAC, F/P/T stakeholders, other interested parties per data sharing agreements
• Interview tool which could be used again by F/P/T stakeholders & broader public health community
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Current Status• Data collection: April 2014 – April 2015• Pilot testing completed:
» Survey length: 10.4 min., 32.5 avg., 75.2 max.» Response rate ~13%
• Changes made to sampling methodology (50/50 Household Type (child/adult) + Next Birthday) & interview script based on pilot testing feedback
• Consumer Food Safety Questions» Stakeholder consultations conducted via short online
survey to prioritize food safety themes» Inclusion in Interview Tool in last 6 months of data
collection
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Stakeholder Engagement• Provincial/Territorial public health authorities• Health Canada
» Food Directorate & Office of Nutrition Policy & Promotion• Canadian Food Inspection Agency
» Food Safety Science Directorate • Food Safety Health Risk Assessment Consortium• Public Health Agency of Canada
» Laboratory for Foodborne Zoonoses» Social Determinants and Science Integration Directorate» Health Promotion and Chronic Disease Prevention
Branch» Data Coordination and Access Program» Centre for Public Health Information and Surveillance
Strategy
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