Foodbook: Canadian Food Exposure Study to Strengthen Outbreak Response Andrea Nesbitt, MSc., Public Health Agency of Canada Canadian Public Health Association, Toronto, Ontario May 29, 2014

Foodbook 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

Background and Rationale Foodbook 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

Purpose Primary Objective: Secondary Objectives: Foodbook 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

Methodology Population-based telephone survey Foodbook 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

Methodology Sampling strategy Foodbook 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

Methodology Inclusion criteria: Exclusion criteria: Foodbook 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

Interview Tool Module 1: Food exposures & frequency (~200 questions) Foodbook 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

Outputs Published reports summarizing: Foodbook 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

Current Status Data collection: April 2014 – April 2015 Foodbook 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

Stakeholder Engagement Foodbook 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

Foodbook Thank you Questions? Contact: Andrea.Nesbitt@phac-aspc.gc.ca or Andrea.Currie@phac-aspc.gc.ca