Assessing food selection in a health promotion program: Validation of a brief instrument for American Indian children in the Southwest United States

Objective Brief dietary assessment instruments are needed to evaluate behav ior changes of participants in dietary intervention programs. The purpose o f this project was to design and validate an instrument for children partic ipating in Pathways to Health, a culturally appropriate, cancer prevention curriculum. Design Validation of a brief food selection instrument, Yesterday's Food Ch oices (YFC), which contained 33 questions about foods eaten the previous da y with response choices of yes, no, or not sure. Reference data for validat ion were 24-hour dietary recalls administered individually to 120 students selected randomly. Subjects The YFC and 24-hour dietary recalls were administered to American Indian children in fifth- and seventh-grade classes in the Southwest United States. Statistical analyses performed Dietary recalls were coded for food items in the YFC and results were compared for each item using percentage agreement and the kappa statistic. Results Percentage agreement for all items was greater than 60%; for most i tems it was greater than 70%, and for several items it was greater than 80% . The amount of agreement beyond that explained by chance (kappa statistic) was generally small. Three items showed substantial agreement beyond chanc e (kappa greater than or equal to 0.6); 2 items showed moderate agreement ( kappa = 0.40 to 0.59); most items showed fair agreement (kappa = 0.20 to 0. 39). The food items showing substantial agreement were hot or cold cereal, low-fat milk, and mutton or chile stew. Fried or scrambled eggs and deep-fr ied foods showed moderate agreement beyond chance. Conclusions Previous development and validation of brief food selection ins truments for children participating in health promotion programs has had li mited success. In this study, instrument-related factors that apparently co ntributed to poor agreement between data from the YFC and 24-hour dietary r ecall were inclusion of categories of foods vs specific foods; food knowled ge, preparation, and vocabulary; item length; and overreporting of attracti ve foods. Collecting and scoring the 24-hour recall data may also have cont ributed to poor agreement. Further development of brief instruments for eva luating changes in children's behavior in dietary intervention programs is necessary. Factors related to the YFC that need further development may be issues that are also important in the development of effective, brief dieta ry assessments for children as individual clients or patients.