F oodbook : Canadian Food Exposure Study to Strengthen Outbreak Response

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. 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 thesedata 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. 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. 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. 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. 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. 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. 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. 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. 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 Questions? Contact: Andrea.Nesbitt@phac-aspc.gc.ca or Andrea.Currie@phac-aspc.gc.ca