1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Foodbook
Thank you
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