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

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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.