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
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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
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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
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Foodbook
Methodology
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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; ondemand verbal translation offered for some other languages
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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
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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
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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)
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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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Foodbook
Outputs
• Published reports summarizing:
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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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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
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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
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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
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