title: Assessing food selection in a health promotion program: validation of a brief instrument for American Indian children in the southwest United States.
abstract: OBJECTIVE
  Brief dietary assessment instruments are needed to evaluate behavior changes of participants in dietary intervention programs. The purpose of this project was to design and validate an instrument for children participating in Pathways to Health, a culturally appropriate, cancer prevention curriculum.
  
  
  METHODS
  Validation of a brief food selection instrument, Yesterday's Food Choices (YFC), which contained 33 questions about foods eaten the previous day with response choices of yes, no, or not sure. Reference data for validation were 24-hour dietary recalls administered individually to 120 students selected randomly.
  
  
  METHODS
  The YFC and 24-hour dietary recalls were administered to American Indian children in fifth- and seventh-grade classes in the Southwest United States.
  
  
  METHODS
  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 items 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 chance (kappa > or = 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-fried foods showed moderate agreement beyond chances.
  
  
  CONCLUSIONS
  Previous development and validation of brief food selection instruments for children participating in health promotion programs has had limited success. In this study, instrument-related factors that apparently contributed to poor agreement between data from the YFC and 24-hour dietary recall were inclusion of categories of foods vs specific foods; food knowledge, preparation, and vocabulary, item length, and overreporting of attractive foods. Collecting and scoring the 24-hour recall data may also have contributed to poor agreement. Further development of brief instruments for evaluating changes in children's behavior in dietary 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 dietary assessments for children as individual clients or patients.
authors.affiliation: Nutrition Program, University of New Mexico, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Koehler
authors.forename: L
authors.initials: L
authors.lastname: Cunningham-Sabo
authors.forename: L C
authors.initials: LC
authors.lastname: Lambert
authors.forename: R
authors.initials: R
authors.lastname: McCalman
authors.forename: B J
authors.initials: BJ
authors.lastname: Skipper
authors.forename: S M
authors.initials: SM
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D002648:Child; D015930:Diet Records; D005260:Female; D005518:Food Preferences; D006293:Health Promotion; D006801:Humans; D007198:Indians, North American; D008297:Male; D011939:Mental Recall; D009516:New Mexico; D015596:Nutrition Assessment; D015203:Reproducibility of Results