Innovation in Measurement for Diet-Related Disease Research: Optimizing Utility and Reach to Reduce Health Disparities

心脏病、癌症和糖尿病是美国十大主要死亡原因中的三个。 所有这些都是与饮食有关的疾病。拉美裔是美国最大的移民人口，但他们的比例参差不齐 慢性疾病的负担，包括患心血管疾病、肥胖和糖尿病的风险。了解 与疾病风险相关的因素和制定适合文化的人口层面干预措施对于 缩小健康差距。然而，这样的研究往往受到缺乏测量工具的阻碍 对于不同的人群，具体的、适当的和有效的；糟糕的测量工具影响了我们对 这可能是疾病风险因素，并可能导致关于干预措施影响的不确定或错误结论。 高质量的测量工具是理解和 评估人群健康，促进饮食相关疾病的科学研究。当无数因素影响着 饮食相关的慢性病风险，在家中消费的食物占美国所有食物支出的一半 并代表影响食物和营养素的最接近和最可改变的因素 人们每天都在消费。然而，有效的家庭食品环境评估工具很少，而且没有。 已经在大量移民或低识字率人群中得到了验证(即，对 用自己的母语书写的)。2008年，我们的团队开发并验证了家庭食品库存 (HFI)使用核对表形式评估家庭食品环境的健康和肥胖风险。我们的 我们的团队已经在NIH资助的研究领域广泛使用了用户管理的HFI仪器 还有其他许多人。引文基准统计数据表明，我们的验证研究文章在全球排名前2% 与同类文章相比。然而，最初的HFI只能用于说英语的人群，相当 篇幅很长，而且是纸质的。我们目前的目标是通过开发一种可访问的 家庭食品环境评估工具包，包括有效和可靠的纸张和多媒体电子 针对已知影响饮食相关健康的食物的工具，这些工具可以由用户在不同的识字水平上进行管理 还有英语和西班牙语。我们的具体目标是：1)将原来的家庭食品库存(HFI)减少到 简化的HFI-core工具，最大限度地提高效用和效率，并将参与者的负担降至最低 保留对饮食相关健康影响最大的食物；2)评估HFI-CORE(英语和西班牙语论文 版本)通过评估可用性、可接受性、有效性和可靠性，并根据需要进行修改；3)开发 电子HFI核心工具(EHFI)，为讲英语的人提供食物的音频和视觉表示，并 以西班牙语为母语的人克服语言和识字问题；4)评估eHFI 通过评估可用性、可接受性、可靠性和有效性，并根据需要修改工具；以及5)促进广泛的 通过永久和易于访问的存储平台使用仪器，并提供支持和 为未来的语言适应和测试提供技术援助平台。

Heart disease, cancer and diabetes are three of the 10 leading causes of death in the United States (US) and all are diet-related diseases. Latinos are the largest immigrant population in the US but they share an uneven burden of chronic disease including risk for cardiovascular disease, obesity and diabetes. Understanding the factors related to disease risk and developing culturally-appropriate population-level interventions are critical to reduce health disparities. Yet, such research is often stymied by the lack of measurement tools that are specific, appropriate, and valid for diverse populations; poor measurement tools cloud our understanding of disease-risk factors and may lead to inconclusive or wrong conclusions regarding the impact of interventions. High-quality measurement tools are part of the essential infrastructure needed for understanding and evaluating population health and advance the science of diet-related diseases. While myriad factors influence diet-related chronic disease risk, food consumed at home accounts for half of all food expenditures among US adults and represent the most proximal and modifiable factors that influence the foods and nutrients that people consume on a daily basis. However, few valid home food environment assessment tools exist and none have been validated with large, immigrant or low-literacy populations (i.e., limited understanding/use of the written form of one’s native language). In 2008, our team developed and validated a Home Food Inventory (HFI) to assess the healthfulness and obesity risk of home food environments using a checklist format. Our user-administered HFI instrument has been used extensively in the field for NIH-funded studies by our team and many others. Citation benchmarking statistics indicate our validation study article is in the top 2% globally compared to similar articles. Yet, the original HFI can only be used with English-speaking populations, is quite lengthy and paper-based. Our present objective is to further advance the science by developing an accessible home food environment assessment toolkit that includes valid and reliable paper and multi-media electronic tools targeting foods known to impact diet-related health that can be user-administered across literacy levels and in English and Spanish. Our specific aims are to: 1) Reduce the original Home Food Inventory (HFI) into a streamlined HFI-core instrument, maximizing utility and efficiency and minimizing participant burden while retaining foods most impactful on diet-related health; 2) Evaluate the HFI-core (English and Spanish paper versions) by assessing usability, acceptability, validity and reliability, and modify as needed; 3) Develop electronic HFI-core tools (eHFI) that present audio and visual representation of foods for English speakers and Spanish speakers in their native language to overcome language and literacy issues; 4) Evaluate both eHFI tools by assessing usability, acceptability, reliability and validity, and modify as needed; and 5) Facilitate broad use of the instruments through a permanent and easily-accessible storage platform and provide support and a technological assistance platform for future language adaptations and testing.