Improving data quality in community-based seafood consumption studies by use of two measurement tools.Introduction To determine whether seafood seafood Edible aquatic animals excluding mammals, but including both freshwater and ocean creatures. Seafood includes bony and cartilaginous fishes, crustaceans, mollusks, edible jellyfish, sea turtles, frogs, sea urchins, and sea cucumbers. contaminated contaminated, v 1. made radioactive by the addition of small quantities of radioactive material. 2. made contaminated by adding infective or radiographic materials. 3. an infective surface or object. with heavy metals heavy metals, n.pl metallic compounds, such as aluminum, arsenic, cadmium, lead, mercury, and nickel. Exposure to these metals has been linked to immune, kidney, and neurotic disorders. , polychlorinated biphenyls polychlorinated biphenyls, (pol´ēklôr´  nā´tid bīfē´n (PCBs), or other hazardous substances
constitutes a public health hazard public health hazard A chemical or other substance known to be hazardous, based on the effects of long-term exposures thereto , the Agency for Toxic Substances and
Disease Registry The United States Agency for Toxic Substances and Disease Registry, (ATSDR) is an agency for the U.S. Department of Health and Human Services that is directed by a congressional mandate to perform specific functions concerning the effect on public health of hazardous (ATSDR ATSDR Agency for Toxic Substances & Disease Registry ), a federal public health agency, has funded
several health departments and academic institutions to conduct health
studies that assess exposure in contaminated areas (ATSDR, 1994, 1995a,
1995b, 1997).
[ILLUSTRATION OMITTED] Contamination from a hazardous waste Hazardous waste Any solid, liquid, or gaseous waste materials that, if improperly managed or disposed of, may pose substantial hazards to human health and the environment. Every industrial country in the world has had problems with managing hazardous wastes. site in coastal Georgia Georgia, country, Asia Georgia (jôr`jə), Georgian Sakartvelo, Rus. Gruziya, officially Republic of Georgia, republic (2005 est. pop. 4,677,000), c.26,900 sq mi (69,700 sq km), in W Transcaucasia. resulted in elevated levels of mercury being detected in soil, sediment sediment, mineral or organic particles that are deposited by the action of wind, water, or glacial ice. These sediments can eventually form sedimentary rocks (see rock). , crab, and oyster oyster, edible bivalve mollusk found in beds in shallow, warm waters of all oceans. The shell is made up of two valves, the upper one flat and the lower convex, with variable outlines and a rough outer surface. samples collected from rivers and tributaries. High levels of mercury also were found in and near several popular fishing areas near the hazardous waste site. As a result of these findings, there was concern that bioaccumulation bi·o·ac·cu·mu·la·tion n. The increase in the concentration of a substance, especially a contaminant, in an organism or in the food chain over time. of mercury might have serious adverse health effects in people eating seafood from this area. Although a commercial fishing and seafood harvesting ban, and a seafood consumption advisory were issued in the area, community residents were concerned about adverse health effects that they might have incurred from eating contaminated seafood. The residents also were concerned that individuals in the area consume far more seafood than the levels used to determine whether consumption of mercury-contaminated seafood poses a likely health threat, and that those individuals might be at substantial risk. In response to these concerns, the Glynn County Health Department and ATSDR conducted a seafood consumption study. In previous seafood consumption studies funded by ATSDR, a standardized standardized pertaining to data that have been submitted to standardization procedures. standardized morbidity rate see morbidity rate. standardized mortality rate see mortality rate. questionnaire was used to elicit e·lic·it tr.v. e·lic·it·ed, e·lic·it·ing, e·lic·its 1. a. To bring or draw out (something latent); educe. b. To arrive at (a truth, for example) by logic. 2. past intake frequency and quantity of seafood consumed con·sume v. con·sumed, con·sum·ing, con·sumes v.tr. 1. To take in as food; eat or drink up. See Synonyms at eat. 2. a. by participants (ATSDR 1994, 1995a, 1995b, 1997). Research has shown, however, that issues with accuracy of recall can bias the results of food consumption to an unknown extent (Joachim 1997, 1998; Ling ling: see cod. , Horwath, & Parnell 1998; Rylander, Stromberg, & Hagmar, 1998). To address data quality concerns of these types in the seafood consumption study conducted in coastal Georgia, food consumption patterns were obtained both through an interviewer-administered questionnaire and through a two-week dietary diary completed by the participant (ATSDR, 1999). It was thought that the use of two instruments employing different methods of data collection would permit more detailed analysis of the data and could reveal discrepancies in responses between the two instruments, improving the reliability of study results. Improving reliability is especially important in reducing recall bias, which generally increases over time. This paper will discuss the use of these two instruments to obtain self-reported seafood consumption levels of study participants as well as the level of agreement between responses from each of the tools. Factors contributing to the value and feasibility of using more than one data collection instrument also are discussed. Methods To determine seafood consumption levels among local residents in coastal Georgia and to assess the accuracy of self-reporting of consumption levels, a seafood consumption study was conducted from May 1996 through April 1997 (ATSDR, 1999). Data collection was conducted over a period of one calendar year to take into account any seasonal variations in seafood consumption. This research was approved by the Institutional Review Board of the Georgia Department of Human Resources The fancy word for "people." The human resources department within an organization, years ago known as the "personnel department," manages the administrative aspects of the employees. in Atlanta. A target group was recruited through canvassing of fishing piers This article contains a list of piers throughout the world. Australia
a preparation containing a palatable food substance such as raw meat, carrot or bran and a pharmaceutical or poisonous substance. The purpose is to introduce the medicament or poison into the unsuspecting animal. and tackle shops, and businesses and households adjacent to affected waterways The list of waterways is a link page for any river, canal, estuary or firth. International waterways
The two data collection instruments used in this study included a questionnaire used in previous ATSDR seafood consumption studies and a dietary diary. The dietary diary was an abbreviated version of the National Fisheries Institute The National Fisheries Institute (NFI) is a United States advocacy organization for the seafood industry and is a member of the International Coalition of Fisheries Associations (ICFA). draft dietary diary (ATSDR, 1999). The questionnaire was administered first by a trained interviewer. Training of interviewers consisted of instruction in the proper administration of the questionnaire and participation in mock <noinclude></noinclude> Wikipedia does not currently have an encyclopedia article for . You may like to search Wiktionary for "" instead. To begin an article here, feel free to [ edit this page], but please do not create a mere dictionary definition. data collection through role-playing role-play·ing n. A psychotherapeutic technique, designed to reduce the conflict inherent in various social situations, in which participants act out particular behavioral roles in order to expand their awareness of differing points of view. exercises. All interviewers were instructed in the confidentiality of the information obtained and, to prevent bias, were not informed of study hypotheses. The questionnaire was divided into sections addressing demographic information, tobacco use and alcohol consumption, prior and current symptoms and illnesses, occupation and other potential sources of mercury exposure, seafood consumption, and fishing/hunting habits. Questions regarding seafood consumption focused on the intake of fresh fish, frozen fish, canned fish, and shellfish shellfish, popular name for certain edible mollusks (see Mollusca), e.g., oysters, clams, and scallops, and for certain edible crustaceans, e.g., crabs, lobsters, and shrimps. All are aquatic invertebrates with shells; they are not fish. . Study participants were asked to describe their weekly level of seafood consumption, how often they bought or caught seafood, where seafood was purchased (local fish market, dockside, private fisherman, restaurant, grocery story), and locations of where they caught seafood (within or outside the advisory area). Once a questionnaire was completed, the interviewer gave the study participant detailed instructions for completing the two-week dietary diary. Study participants were asked to record their daily protein consumption, including beef, pork pork, flesh of swine prepared as food, one of the principal commodities of the meatpacking industry. Pork has long been a staple food in most of the world, although religious taboos have limited its use, especially among Jews and Muslims. , poultry poultry, domesticated fowl kept primarily for meat and eggs; including birds of the order Galliformes, e.g., the chicken, turkey, guinea fowl, pheasant, quail, and peacock; and natatorial (swimming) birds, e.g., the duck and goose. , seafood, and wild game, specifying the meal at which the item was eaten (i.e., breakfast, lunch, dinner, or snack). Also recorded in this diary were whether the food had been eaten at home or away from home, whether the item had been purchased or caught, and an estimate of the portion size made with a detailed portion guide for uniformity. Information regarding location was recorded if seafood or wild game was classified as being caught. The current day's food consumption was entered by the interviewer for the first day of the two-week period, to serve as an example for study participants to follow on subsequent days. Detailed but concise written instructions were attached for easy reference to the dietary diary. Study staff contacted each participant by phone two to three days later to answer questions or address problems he or she might be encountering when completing the dietary diary. In addition, a contact name and number were provided to all study participants in case they had any questions regarding the dietary diary. At the end of the two weeks, the dietary diary was collected in person and reviewed at that time for completeness. If the diary was incomplete, study staff worked with the participant to complete the required information. [FIGURE 1 OMITTED] Information collected from study participants in the questionnaire and the dietary diary was used to determine seafood consumption levels and to assess the accuracy of self-reported seafood consumption. The authors compared responses from the two data collection instruments in two ways: 1) by examining the overall amount of seafood in the diet and 2) by comparing the number of seafood meals consumed per week. The overall amount of seafood in the diet was evaluated by comparison of self-reported levels of seafood consumption in the questionnaire (i.e., "none," "a little," "moderate," and "a lot") with the proportion of seafood in the diet as reported in the dietary diary. In other words Adv. 1. in other words - otherwise stated; "in other words, we are broke" put differently , the amount of seafood a person thought he or she consumed was compared with the proportion of seafood in the diet as recorded in the two-week dietary diary. In addition, the number of seafood meals consumed per week was evaluated through comparison of questionnaire responses about seafood consumption (i.e., less than once a week, once a week, and more than once a week) with the average of seafood meals per week in the two-week dietary diary (i.e., total number of seafood meals recorded in the two-week dietary diary divided by two). To measure the agreement of weekly seafood consumption between the questionnaire and the dietary diary with respect to weekly seafood consumption, the Kappa statistic statistic, n a value or number that describes a series of quantitative observations or measures; a value calculated from a sample. statistic a numerical value calculated from a number of observations in order to summarize them. ([kappa]) with 95 percent confidence interval confidence interval, n a statistical device used to determine the range within which an acceptable datum would fall. Confidence intervals are usually expressed in percentages, typically 95% or 99%. (CI) was used (Rosner, 2000). The Kappa statistic measures reproducibility reproducibility Lab medicine The degree of agreement among repeated measurements of a particular parameter, presented in terms of a standard deviation or coefficient of variation of the results in a set of measurements between instruments by comparing the observed concordance rate concordance rate n. A quantitative statistical expression for the concordance of a given genetic trait, especially in pairs of twins in genetic studies. with the expected concordance rate. The observed concordance rate ([p.sub.o]) is the number of similar responses in the two instruments divided by the total number of responses. The expected concordance rate ([p.sub.e]) is calculated on the basis of the row and column margins of the contingency table contingency table n. A statistical table that shows the observed frequencies of data elements classified according to two variables, with the rows indicating one variable and the columns indicating the other variable. . The Kappa statistic is [kappa] = ([p.sub.o] - [p.sub.e]/1 - [p.sub.e]). (A value of [kappa] > 0.75 denotes excellent reproducibility, 0.4 [less than or equal to] [kappa] [less than or equal to] 0.75 denotes good reproducibility, and 0 [less than or equal to] [kappa] [less than or equal to] 0.4 denotes marginal reproducibility.) For the purposes of this study, information collected from study participants in the target and comparison groups was combined. Results A total of 404 individuals completed the screening survey and were eligible to participate in this study. Approximately three-quarters of these eligible individuals participated in the study (n = 316; 78 percent). Of these, 138 completed the questionnaire and 178 completed the questionnaire and dietary diary. The majority of study participants who completed the questionnaire and the majority who completed both the questionnaire and the dietary diary were white, 40 years of age or older, and from the target group (Table 1). There were no statistically significant differences with respect to gender, race, or assignment to the target group or comparison group among study participants who completed one or both data collection instruments. There was, however, a statistically significant difference with respect to the age groups and educational levels of these individuals. To determine the amount of seafood in the diet, the authors compared self-reported levels of seafood consumption in the questionnaire with the amount of seafood participants reported consuming during the two-week dietary diary. The interviewer-administered questionnaire ascertained as·cer·tain tr.v. as·cer·tained, as·cer·tain·ing, as·cer·tains 1. To discover with certainty, as through examination or experimentation. See Synonyms at discover. 2. self-reported consumption levels by asking study participants to describe their level of seafood consumption as "none," "a little," "moderate," or "a lot." The amount of seafood in the diet was calculated as the proportion of seafood consumed in relation to all protein sources (i.e., beef, poultry, pork, seafood, and wild game) during the two-week period covered by the dietary diary. Overall, as the level of reported seafood consumption rose on the nominal scale See: principal scale; scale. in the questionnaire (i.e., from "none" to "a little" to "moderate" to "a lot"), so did the mean percentage of seafood in the diet as recorded in the dietary diary (Figure 1). There were no individuals who described their level of seafood consumption as "none" on the questionnaire or who recorded not eating seafood in the dietary diary. Individuals who classified themselves as eating "a little" seafood in the questionnaire (n = 57) recorded that 15 percent of their diet consisted of seafood. Individuals who classified themselves as eating a "moderate" amount of seafood (n = 84) recorded that 18.5 percent of their diet consisted of seafood, while those who classified themselves as eating "a lot" of seafood (n = 37) recorded that 26.5 percent of their diet consisted of seafood. To assess the reproducibility of self-reported seafood consumption on two different data collection instruments, the number of seafood meals consumed per week was compared as reported on the questionnaire and in the diary (Table 2). In the questionnaire, the majority of respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. (n = 124; 70 percent) reported consuming seafood more than once a week, while less than one-fifth reported consuming seafood once a week (n = 25; 14 percent) or less than once a week (n = 29; 16 percent). In the dietary diary, slightly less than one-half of study respondents recorded eating one seafood meal a week (n = 80; 45 percent), while over one-third recorded eating less than one seafood meal a week (n = 70; 39 percent). Less than one-fifth of study participants recorded eating more than one seafood meal a week (n = 28; 16 percent). On the basis of the data in Table 2, [kappa] = 0.13 (95 percent CI: 0.06-0.20), which denotes marginal reproducibility between the two instruments. Analyses also were conducted to examine demographic differences between individuals whose responses to the questionnaire and recorded consumption in the dietary diary were in agreement and those whose responses were not (Table 3). There were no statistically significant differences with respect to gender, race, educational level, or assignment to the target group or the comparison group. There was, however, a statistically significant difference with respect to the age of these individuals: Younger individuals had better agreement than older individuals. Discussion This study afforded an opportunity to examine reported seafood consumption in an area where mercury-contaminated seafood had been sampled. The use of two data collection instruments focusing on seafood consumption allowed the authors to make comparisons to see if results were consistent. The questionnaire provided a broad picture of consumption patterns, while the dietary diary provided details of these consumption patterns. Use of similar but differently stated and focused questions in the two instruments facilitated meaningful comparisons for further analysis. Overall, the findings indicate that with a questionnaire, individuals were able to make broad generalizations about the amount of seafood in their diet but were less accurate in estimating specific seafood consumption levels. Results from this study also indicate that there was a low level of concordance concordance /con·cor·dance/ (-kord´ins) in genetics, the occurrence of a given trait in both members of a twin pair.concor´dant con·cor·dance n. between the questionnaire and dietary diary with respect to levels of seafood consumption. Because of data quality concerns arising from previous seafood consumption studies, the authors decided to incorporate two data collection instruments into the study to elicit information regarding seafood consumption. Although the questionnaire required training of interviewers, it was relatively easy to implement and provided a broad picture of consumption patterns in the area, including information on fishing locations. The dietary diary, on the other hand, was more time-consuming to implement, and it required training of study participants and periodic follow-up follow-up, n the process of monitoring the progress of a patient after a period of active treatment. follow-up subsequent. follow-up plan by study staff, but it provided more detailed information regarding seafood consumption. Inclusion of the dietary diary in the study greatly reduced participation rates, however. This study was conducted because community residents were concerned that they consumed more seafood than the levels used to determine whether consumption of mercury-contaminated seafood poses a likely health threat. The information collected in the questionnaire did not provide enough specific information on consumption levels to adequately address this concern. The detailed information obtained from the dietary diary allowed the authors to examine the appropriateness of the intake values used to develop the seafood advisory in the area. Although less than one-half of eligible study participants completed the dietary diary, the majority of these individuals were from the target group who were selected because they ate locally caught seafood. Community residents were surprised that seafood consumption levels were less than they had anticipated since it was believed that more people in the area were subsistence subsistence, n the state of being supported or remaining alive with a minimum of essentials. fishers. Results from this study answered questions they had regarding seafood consumption levels in their area, however, and reduced fears about the risk of adverse health effects from mercury exposure. Investigators may be wary of incorporating data collection instruments such as dietary diaries into studies because of the time it takes to complete these documents and the resources needed to implement such activities. This concern is especially relevant if the food consumption portion of the study is not the main focus of the research being conducted. The authors found that resources can be conserved con·serve v. con·served, con·serv·ing, con·serves v.tr. 1. a. To protect from loss or harm; preserve: by training the study participants to accurately record their food consumption so that once trained, only periodic staff follow-up is needed. Researchers also can conserve resources by using standardized instruments rather than developing new ones. Incorporating a dietary diary into a community-based study may require more effort on the part of the investigators, but the detailed information it provides can be invaluable when one is addressing community concerns. For investigators examining consumption patterns in a community, the decision of whether to use a questionnaire or dietary diary will be influenced by the objectives of the study, the level of community concern, the number of study staff, and available resources.
TABLE 1 Demographic Characteristics of Study Participants
Completed
Completed Questionnaire and [X.sup.2] Degrees
Questionnaire Dietary Diary of Freedom
Characteristic Only (n = 138) (n = 178) (p-value)
Gender 0.37
Male 73 (53%) 88 (49%) 1
Female 65 (47%) 90 (51%) (.54)
Age
<10 years 13 (9%) 4 (2%)
10-19 years 13 (9%) 9 (5%) 13.44
20-29 years 14 (10%) 13 (7%) 6
30-39 years 16 (12%) 29 (16%) (.04)
40-49 years 15 (20%) 29 (16%)
50-59 years 20 (14%) 29 (16%)
60 and over 47 (34%) 65 (37%)
Race
White 124 (90%) 165 (93%) 1.11
African- 11 (8%) 9 (5%) 2
American
Other/unknown 3 (2%) 4 (2%) (.37)
Education
(individual)
Elementary 33 (13%) 8 (4%)
school
High school 55 (43%) 80 (45%) 28.33
Community/ 11 (9%) 19 (11%) 5
technical
college
Four-year 30 (28%) 60 (34%) (0.00)
college
Graduate school 4 (4%) 7 (4%)
None/refused 5 (3%) 4 (2%)
Group 0.57
Target 89 (64%) 122 (69%) 1
Comparison 49 (36%) 56 (31%) (.45)
TABLE 2 Concordance of Weekly Seafood Consumption Reported in the
Questionnaire and Recorded in the Dietary Diary
Questionnaire
Questionnaire Dietary Diary* Total
<1 serving/ 1 serving/ >1 serving/
week week week
<1 serving/week 19# 6 0 25
1 serving/week 16 13# 0 29
>1 serving/week 35 61 28# 124
Dietary Diary
Total 70 80 28 178
*Calculated as the average number of servings per week. Bold font
indicates concordance between the two data collection instruments.
Note: concordance between the two data collection instruments indicated
with #.
TABLE 3 Selected Demographic Characteristics of Participants, by
Agreement or Nonagreement of Questionnaire and Diary with Respect to
Seafood Consumption Levels
[X.sup.2] Degrees
Agreement No Agreement of Freedom
Characteristic (n = 60) (n = 118) (p-value)
Gender .01
Male 30 (50%) 58 (49%) 1
Female 30 (50%) 60 (51%) (.91)
Age
<10 years 2 (3%) 2 (2%) 15.35
10-19 years 7 (12%) 2 (2%) 6
20-29 years 4 (7%) 9 (8%) (0.1)
30-39 years 12 (20%) 17 (14%)
40-49 years 12 (20%) 17 (14%)
50-59 years 10 (17%) 19 (16%)
60 and over 13 (22%) 52 (44%)
Race 2.13
White 54 (90%) 111 (94%) 2
African-American 5 (8%) 4 (3%) (.36)
Other/unknown 1 (2%) 3 (3%)
Education (individual)
Elementary school 6 (10%) 2 (1%) 6.90
High school 27 (45%) 53 (45%) 5
Community/technical 19 (32%) 41 (35%) (0.26)
college
Four-year college 2 (3%) 5 (4%)
Graduate school 5 (8%) 14 (12%)
None/refused 1 (2%) 3 (3%)
Group 0.002
Target 41 (68%) 81 (69%) 1
Comparison 19 (32%) 37 (31%) (.97)
Acknowledgements This work was wholly supported by funds provided to the Glynn County Health Department by the Agency for Toxic Substances and Disease Registry, U.S. Department of Health and Human Services Noun 1. Department of Health and Human Services - the United States federal department that administers all federal programs dealing with health and welfare; created in 1979 Health and Human Services, HHS , according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA CERCLA Comprehensive Environmental Response, Compensation, and Liability Act (aka SuperFund) ), under grant number UT50-ATU482229-02-03. The authors would like to thank the staff of the Coastal Health Unit, Dr. Randy Manning, the study participants, and the members of the Seafood Advisory Group for their dedication and contributions to this project. REFERENCES Agency for Toxic Substances and Disease Registry (1994). Health study to assess methylmercury exposure among members of the Fond du Lac Fond du Lac (fŏn` də lăk', –jə–), city (1990 pop. 37,757), seat of Fond du Lac co., E central Wis., in a resort region at the south end of Lake Winnebago; inc. 1852. Band of Chippewa Indians in northern Minnesota. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Agency for Toxic Substances and Disease Registry (1995a). Health study to assess the human health effects of mercury exposure to fish consumed from the Everglades. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Agency for Toxic Substances and Disease Registry (1995b). 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(1998) Validation See validate. validation - The stage in the software life-cycle at the end of the development process where software is evaluated to ensure that it complies with the requirements. of a short food frequency questionnaire to assess consumption of cereal cereal or grain Any grass yielding starchy seeds suitable for food. The most commonly cultivated cereals are wheat, rice, rye, oats, barley, corn, and sorghum. As human food, cereals are usually marketed in raw grain form or as ingredients of food products. food, fruit and vegetables in Chinese Singaporeans. European Journal European Journal is a weekly Deutsche Welle (DW) news program produced in English. It is broadcast from Brussels, Belgium and primarily covers political and economic developments across the European Union and the rest of Europe, as well as issues of particular concern to of Clinical Nutrition Clinical nutrition The use of diet and nutritional supplements as a way to enhance health prevent disease. Mentioned in: Naturopathic Medicine , 52(8), 557-564. Rosner, B. Fundamentals of biostatistics biostatistics /bio·sta·tis·tics/ (-stah-tis´tiks) biometry. bi·o·sta·tis·tics n. The science of statistics applied to the analysis of biological or medical data. . (2000). Pacific Grove Pacific Grove, residential and resort city (1990 pop. 16,117), Monterey co., W central Calif., on a point where Monterey Bay meets the Pacific Ocean; inc. 1889. , CA: Brooks/Cole Publishing Company. Rylander, L., Stromberg, U., & Hagmar, L. (1998). Agreement between reported fish consumption obtained by two interviews and its impact on the results in a reproduction study. European Journal of Epidemiology epidemiology, field of medicine concerned with the study of epidemics, outbreaks of disease that affect large numbers of people. Epidemiologists, using sophisticated statistical analyses, field investigations, and complex laboratory techniques, investigate the cause , 14(1), 93-97. Dhelia M. Williamson, M.S. Evelyn Choury Roberta Hilsdon Brooks Taylor, M.D. Corresponding Author: Dhelia M. Williamson, Epidemiologist epidemiologist an expert in epidemiology. , Division of Health Studies, Agency for Toxic Substances and Disease Registry, 1600 Clifton Rd., MS E-31, Atlanta, GA, 30333, E-mail: djw8@cdc.gov. |
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