PUBHLTH 516

Data Exploration
45 points
Group 11: Corinn Bryant, Isabel Hermsmeyer, Jackson Holliday Bensley, Omar Syed Ilyas, Soverno
Chen

Learning Objectives:
● To explore a complex public health problem through quantitative and qualitative data
● To identify and provide examples of quantitative and qualitative data
● To recognize qualitative data collection as a means to explore multi-sector perspectives

Instructions:
As a group, complete this worksheet by answering the following questions. Once completed,
one group member can upload the worksheet to Canvas on behalf of the group.

1. In your team, decide on a public health challenge that you would like to focus on
together throughout the course. Take some time to identify a challenge that is of
interest and meaningful to your group (you will use this to frame future class projects).
List the public health challenge here. [5 points]

Global perspective of Nutrition leading to chronic diseases, specifically a westernized

diet

2. Propose how you could gather both quantitative and qualitative data to better
understand the public health challenge. In your response, describe 2 quantitative data
collection methods and 2 qualitative data collection methods that will further your
understanding of the issue. For each, provide a specific example and explain the benefit
of using that particular method. [12 points]

Quantitative Methods:
One quantitative method could be using a mouse model to look at differences in
nutrient composition in diet and resulting disease in mice, which is helpful as everything
else can be more or less controlled for in order to determine causation.
Another quantitative method could include comparing rates of chronic diseases
alongside rates of western food sources in non-western countries. This quant method
would be inexpensive and simple to execute.

Qualitative Methods:
 A qualitative method to correspond with this would be to interview people in
non-western countries on their perspective of integrating western diets and health in
their respective countries. More specifically This would further allow us to parse through
the nutritive contributions to diet and health.
Another qualitative method could be doing survey collection on dietary
composition and health, which again would be inexpensive and would be able to reach
many different people.

3. Explore data that is already available (such as published manuscripts, reliable web
resources, etc.) to gain a broader understanding of the public health challenge. From
your review of data, in the table below, briefly summarize key findings in your own
words from 3 different sources that inform your understanding of the issue. For each of
the sources, include a reference to the data source and mention if the data is
quantitative or qualitative. In your response, include both quantitative and qualitative
data. [12 points]
Summarize Key Finding Reference Type of Data

1. Standard american diet (SAD) Grotto, D. and Zied,

combined with inactivity may be the E., 2010. The Meta review
standard American
driving force behind many of the diet and its
health challenges in the United relationship to the
States today health status of
Americans. Nutrition
in Clinical Practice,
25(6), pp.603-612.

2. Totsch, S.K., Quinn,

negative effects of an American diet T.L., Strath, L.J., experimental
on physiology, behavior and McMeekin, L.J.,
recovery from injury. SAD Cowell, R.M.,
consumption elevated Gower, B.A. and
pro-inflammatory mediators and Sorge, R.E., 2017.
increased microglial activation in the The impact of the
spinal cord. Standard American
Diet in rats: Effects
on behavior,
physiology and
recovery from
inflammatory
injury. Scandinavian
journal of pain,
17(1), pp.316-324.
 3. high fast food density in Taiwan Chiang, P.H.,
increased the risk of general (BMI) Wahlqvist, M.L., Cross sectional
and abdominal (waist Lee, M.S., Huang,
circumference) obesity in boys and L.Y., Chen, H.H. and
stature in girls Huang, S.T.Y., 2011.
Fast-food outlets
and walkability in
school
neighborhoods
predict fatness in
boys and height in
girls: a Taiwanese
population study.
Public health
nutrition, 14(9),
pp.1601-1609.

4. Based on the data you explored and your review of the literature in general, describe a
specific action or intervention that public health leaders might consider in addressing
the public health challenge. Write this out in one or two sentences. [5 points]

Moderating the accessibility of the standard American diet as well as fast food (which is
either directly from the west or potentially inspired by) within a population to
discourage consumption, modifying and incentivizing alternatives through funding to
increase access to healthier options.

5. How might key informant interviews from people outside the public health profession be
useful in understanding the challenge your group selected? Respond in a few sentences.
[5 points]

Outside of public health is a great way to get a different perspective and facilitate a more
interdisciplinary approach to this sort of work. For biological anthropology specifically, there is
an ability to garner an evolutionary and mechanistic understanding of the physiology behind
this modern health problem.
Key Topic 2: An Intervention or Action[4 mins]

3. What is your perspective on the sugar sweetened beverage tax?

4. What is your perspective on the portion sizes in the U.S?
1. Differences somewhere else?

Key Topic 3: stakeholders and partnerships [2 mins]

5. What other organizations/teams/individuals do you work with directly related to

nutrition, and outside of nutrition?
1. Are there any international partners?
2. Are there partnerships you would like to form?
3. Are there barriers in forming needed partnerships?

Key Topic 4: governance/power/authority [3 mins]

6. When we think about cross-sector partnerships, issues of governance, power, or

authority might come into play.
Are there policies or regulations that you have to work within that make it harder
to complete your work and mission in regards to nutrition and chronic disease?
How do you navigate this tension?

Key Topic 5: interprofessional practice [3 mins]

7. Interprofessional practice principles include values and ethics,

roles/responsibilities, teams and teamwork, and communication. Which of these
principles do you think are most important for working in teams to address the
impact that nutrition has on the development of chronic disease?

CLOSING: thank the interviewee and close the meeting. [2 mins]

Interviewer 1: You’ve answered our questions. Thank you very much for your time and
for sharing your insights with us.

Do you have any additional comments about … that we haven’t yet covered?

Again, thank you very much.

 Assignment 4 - Key Informant Interview and Analysis

PUBHLTH 516: Leadership Skills for Interprofessional Practice

Group 11: Corinn Bryant, Soverno Chen, Dania J Harris, Isabel Hermsmeyer, Omar
Ilyas, and Jackson Bensley
Key Informant Interview 1
Interviewees: Miranda Cosman, Skeletal Biology Lab Manager
Interview format: Face to face interview with note-taking to accommodate the preferences of the
interviewee

Transcript 1:

INTRODUCTION: say who you are/your affiliation[3 mins]

Interviewer 1: Hello, as you know my name is Isabel. I am a PhD student at the

University of Michigan in the anthropology department. I am collecting information for a
class project focused on engaging cross-sector partners to address public health
challenges. Our team is focusing on looking at a global perspective of nutrition leading
to chronic diseases, and more specifically how a westernized diet relates to this. Thank
you for meeting with us today.

Interviewer 1: We are aiming for this interview to take no more than 20 minutes. We’re
interested in your perspectives regarding the global perspective of nutrition leading to
chronic diseases, and more specifically how a westernized diet relates to this concept.
During this face to face interview I will be taking notes to record your responses. Is that
okay?

Verbal confirmation from participant to participate was recieved.

Interviewee background information [3 mins]

Interviewer 1: To start, would you please describe your organization’s role and
describe your role at UM and what your work focuses on. Do you work with a team as
part of this role?

Interviewee 1:
● The skeletal biology lab is primarily focused on researching environmental
impacts on bone, including the impact of nutrition on bone.
● We do a lot of collaboration, like with researchers at the hospital or other
universities, but the team is primarily the lab members.

Interviewer 1: What are the most concerning challenges of the impact of a westernized
diet on chronic disease development?

Interviewee 1:
 ● It is primarily an issue in adolescent growth, as the teenage years are some of
the most critical for lifelong bone density and strength. This can have an impact
on later life development of chronic diseases like osteoporosis.
● Obesity and metabolic disease are both seen to decrease skeletal acquisition in
mice, and so is a high fat diet.

Key Topic 2: An Intervention or Action[4 mins]

Interviewer 1: What is your perspective on the sugar sweetened beverage tax?

Intevriewee 1: Is generally in support of this idea, it could be effective in bringing down

rates of obesity in the population.

Interviewer 1: What is your perspective on the portion sizes in the U.S and do you think
there are differences somewhere else?

Interviewee 1: Portion sizes are huge! I am not sure how effective policing portion sizes
at restaurants could be, but they’re definitely a cultural problem in this country.

Key Topic 3: stakeholders and partnerships [2 mins]

Interviewer 1: What other organizations, teams, or individuals do you work with directly
related to nutrition, and outside of nutrition?

Interviewee 1: There are not really any that are directly related to nutrition, though it is
commonly an aspect of the work we do together in research.

Interviewer 1: Are there any international partners?

Interviewee 1: Yes, we collaborate with a few researchers at international universities,

but not in nutrition.

Interviewer 1: Are there partnerships you would like to form?

Interviewee 1: Yes, a stronger relationship with the MNORC (Michigan Nutrition

Obesity Research Center)

Interviewer 1: Are there barriers in forming needed partnerships?

Interviewee 1: Simply networking, finding the right connection in.

Key Topic 4: governance/power/authority [3 mins]

Interviewer 1: When we think about cross-sector partnerships, issues of governance,

power, or authority might come into play. Are there policies or regulations that you have
to work within that make it harder to complete your work and mission in regards to
nutrition and chronic disease? How do you navigate this tension?

Interviewee 1: We have to navigate around issues with IACUC (institutional animal

care and use committee) for our mouse model studies, and IRB when working with
humans. Generally, we do not run into problems with these policies as we follow the
standards required to get approved.

Key Topic 5: interprofessional practice [3 mins]

Interviewer 1: Interprofessional practice principles include values and ethics,

roles/responsibilities, teams and teamwork, and communication. Which of these
principles do you think are most important for working in teams to address the impact
that nutrition has on the development of chronic disease?

Interviewee 1: Respect and communication, definitely. The biggest issue in

collaboration is the extra time it takes than simply doing research independently, and
communication is key for making sure everybody is on the same page to move forward.

CLOSING: [2 mins]

Interviewer 1: So you have answered all of our questions. Thank you very much for
your time and for sharing your insights with us. Do you have any additional comments
relating to a global perspective of nutrition leading to chronic diseases or about how a
westernized diet relates to this that we haven’t yet covered?

Interviewee 1: Indicated they have not further comments.

Interviewer 1: Okay well again, thank you very much. Have a good day.

Identified Codes:
Organization Purpose, Partnerships, Teams, Westernized Diet, Health, Obesity, Sugar-Sweetened Beverage
Tax, Portion Sizes, Food Systems, International Eating Patterns, Research, Policy
Key Informant Interview 2
Interviewees: Lissa Goldstein, Owner of Wild Work Farm
Interview format: Zoom interview with the recorded transcript. Interviewee provided
verbal confirmation to participate in the zoom interview and for it to be recorded after
introduction.Transcript was modified after completion of interview to correct zoom mis-
transcription and remove off-topic conversation (i.e. presence of cute infant).

Transcript 2:

Interviewer 2: um, can you please describe your role in wildwork farm and your
organization's role within the food system.

Interviewee 2: i'm sure well my role is that i'm the owner of the business, so I am
responsible for all the business side of things, so all the finances all the hiring all that
stuff and then i'm also kind of like the manager of the farm itself so training. Just kind of
getting things done, but I have more and more employees who are capable of those
things too, and then our farm. Mostly grows food for very local community. We sell food
to our local community so we're like a very localized farm within our you know I wouldn't
say, like most people are getting sound like most people are getting the bulk of their
food from us, but. You know, we provide fruit, fruit and veggies to like I mean we have
150 CSA members and then all the other families, and so you know in season, I would
say, like there's a decent number of local people that are getting you know, the majority
of their veggies from us.

Interviewer 2: question number two. Oh well, part of Question one, and I think you
touched on it, but like do you work while you work with the team as a part of this role.

Interviewee 2: yeah I work with the team as a part of my role, and then I would say, like
obviously we work with like other local farmers to grow food for people.

Interviewer 2: What are the most concerning challenges of the impact of a Westernized
diet on chronic disease. That you can see, or or like just from your perspective.

Interviewee 2: yeah I mean I, the main thing I think is just like how many processed
foods we eat, so how much just like.You know, we don't have enough time for cooking
so people are buying a lot of convenience foods, a lot of frozen foods, a lot of prepared
foods, and I think just those have like a lot of artificial ingredients in them and then more
probably more salt and fat. Which i'm not against salt and fat, but I think that they're just
like not as many redeeming qualities, people are probably eating less fruit and veggies
because they take more time to prepare and they're not in their perishable and I think
part of the Westernized diet is just like yeah it can be manson and speed yeah. mm
hmm.

Interviewer 2: What is your perspective on the sugar sweetened beverage tax? Do they
have that in New York?

Interviewee 2: I don't know, but I think that's a great idea yeah I mean, I think that, like,
I mean I don't you know I mean I don't think there's anything. wrong with having a drink,
you know soda now and then, but like. If there's a tax, you know, maybe it would
incentivize people not to like go to that as they're like first choice or not to be drinking,
you know drink more water less coke you know that kind of thing so yeah I mean.

Interviewee 2: Why not be taxed cigarettes, we tax alcohol, I think I mean just seems
like a good idea. It’s a cost to the Food system.

Interviewer 2: um and then, what is your perspective on the portion sizes in the US.

Interviewee 2: um. I mean I don't really know I know that Canadians always said, like
oh it's too much, and I think probably when you go out to you, they give you a lot, I
mean i'm a pretty big eater so I like big portions but I I don't think that should be like
expectation. I don't know. it's like hard to say it's like okay for someone like Steve or me
where you're like physically working on there an athlete or something it's like. I don't
know, maybe actually like need more food and like it's Okay, but like should that be like
the norm if someone's just like. yeah they're probably too big, but because I don't have
like I don't know a I don't go out to eat that much and be like I don't know if it's like big in
people's homes to I think probably people are eating like bigger portions of meat than
they need to. I also think like now it's interesting like. When I you know, like 10 years
ago, or whatever, like a lot of this stuff was like Oh, people are obese kids are too fat
everyone's obese, and now i'm noticing there's also this like kind of parallel
perpendicular thing happening, which is that, like. it's not necessarily right to like shame
people you know by are you getting that in school? yeah positivity and like that. yeah
health is one thing, but also just like some people are fat, some people are thin like
different body sizes is not always an indicator of health or bad health or bad, and that
you know it doesn't mean you're like a bad person, so I think it's like kind of getting into
tough territory to be like policing these things I guess it's just like hard to say it's like
hard to make a general statement about it.

Interviewer 2: yeah absolutely and I guess, my question was to with that were you in
Africa at one point.
Interviewee 2: yeah

Interviewer 2: Okay, I guess, I was curious like if you noticed a difference, just in like.
This is kind of off topic and questions that I have but. In terms of like you living there,
and Canada and here like just kind of that I feel like that's a more broad scope of I
guess diets in general as well.

Interviewee 2: Well, in East Africa the diet is like pretty limited like there's definitely less
processed foods, unless you have money and you live in a city, otherwise it's like corn
and beans and like maybe some meat and the portion sizes are big but, the foods are
less fatty. They're not processed and people aren't snacking as much it's kind of like
they have like two bigger meals and breakfast is usually pretty light. And then in
Canada, I do think the portion sizes, probably in general are smaller but like there's still
like where Steve from Alberta, where everyone like eats like a massive steak you know
and there's still those restaurants, that have kind of like American style portions. But I
think again like I think Americans are more, I think we're like I think our processed food
snack food lobby is like stronger. I just think we have like. more of an attachment to like
snacks and snacking and eating and like it's just not. And we are also worse at like
having a meal. I think so anymore it's like more culturally than like the physicality of the
food too it's like we don't we're not always good at having mealtime. it's like I know so
many people that like don't eat meals or don't or like. yeah just don't I don't know like to
stay in think we just don't necessarily like not the three meals, a day is the answer, but I
just think like we don't always give eating the time it needs.

Interviewer 2: yeah they're not structured sure

Interviewee 2: You know I’m eating standing up, eating on my phone whatever you
know it's like, but I think that that's worse here.

Interviewer 2: yeah I would agree um.

Interviewer 2:Okay, what organizations or teams and individuals do you work with
directly related to nutrition or also outside of nutrition.

Interviewee 2: Only one we work with is WIC, which is the women infant and children
nutrition coupons and then there's the seniors one to that we work with.

Interviewee 2: and outside of that it's pretty much just like occasional contact with food
shelves.
Interviewee 2: there's like a nonprofit here that works, a little bit with like food act on
food access.

Interviewee 2: yeah.

Interviewer 2: um are there partnerships that you would like to form or i'd like to see
more of.

Interviewee 2: I mean yeah I would love for there to be like more networking around
food access and like getting food to people who are going to use it and goodness, I
mean there's an organization here called hop on the Hill and they do a lot of things, but
during the pandemic they started like delivering these food boxes to people, which I
think is great, and I would love to be part more part of that, but I also feel like I just like
also hope that that people are using it, you know that they're getting it that it's not just
like look we're getting this to people it's like Oh, people are actually like Eating it and
yeah it's like what they want.

Interviewer 2: Wait this is okay when we think about cross sector partnerships, issues
of governance power or authority might come into play. Are their policies or regulation
that you have to work within that make your hardest to complete your work and mission
in regards to.Whether or not, that would affect nutrition and chronic disease.

Interviewee 2: Oh policies. Not like super direct, not that I know of super directly, I
would say, like probably just like the way, politics is and, like the fact that, like more
money goes to big AG, which then feeds into these processed foods and then there's a
less subsidies and like money going to small like or, or other veggie funds which. Then
would, could potentially… if as much emphasis and power was put on like vegetable
farms, as it is until like commodities and like these industries and then yeah and I
suppose that that would probably affect like health.

Interviewer 2: How would you say you would either like navigate that tension or would.
Work how or could work to alleviate that. Like the discrepancy between

Interviewee 2: um. I mean, I think, like advocacy or I think there's definitely more yeah I
think like political advocacy and yeah finding ways around the prevalence of like
processed foods mainly just making our foods more . getting them in as many places as
possible, making sure there's no barriers for people to be getting them that kind of thing.

Interviewer 2: mm hmm.
Interviewee 2: So like having fruit, vegetables in like Stewart you know the gas station
that could be that's something I had thought about.

Interviewer 2: yeah you're good.

Interviewee 2: At something I find out, you know when we first moved here would be
cool like. You know that's like a place people go there's a lot of like shitty processed
food that's essentially like a convenience store.

Interviewer 2: i'm Okay, my last question. Inter professional practice principles include
values and responsibilities. Which These principles do you think are most important and
working. Important for working in teams to address the impact that nutrition has on the
development of chronic diseases.

Interviewee 2: Communication I don't know what were the other ones?

Interviewer 2: I can yeah inter professional so values and ethics roles responsibilities
teams and teamwork and communication. And then, which yeah are the most important,
and working.

Interviewee 2: With teams and teamwork are part of communication.

Interviewer 2: No they're separate.

Interviewee 2: I think communication just sharing information across different sectors

like the public health sector and our food and agriculture sector and, like the grocery
sector, you know, like, I think all those different groups.

Interviewer 2: Okay, great. *I am going to pause the recording now.*

Identified Codes:

Job Role, Team, Organization Purpose, Nutrition, Partnerships, Westernized Diet, Sugar-Sweetened Beverage
Tax, Policy, International Eating Pattern, Meals, Portion Size, Obesity, Body Size, Food Systems, Food
Access, Funding

Key Informant 1 CODE: Miranda Cosman

(Present skeletal biology lab manager)
Interviewer: Isabel Hermsmeyer
Codes Transcript Text

Organization “The skeletal biology lab is primarily focused on researching

Purpose environmental impacts on bone, including the impact of nutrition on
bone.”

Partnerships “We do a lot of collaboration, like with researchers at the hospital or

other universities”

Teams “We do a lot of collaboration, like with researchers at the hospital or

other universities, but the team is primarily the lab members.”

Westernized Diet “Interviewer 1: What are the most concerning challenges of the
impact of a westernized diet on chronic disease development?
Interviewee 1: It is primarily an issue in adolescent growth, as the
teenage years are some of the most critical for lifelong bone density
and strength. This can have an impact on later life development of
chronic diseases like osteoporosis.”

Health
“Obesity and metabolic disease are both seen to decrease skeletal
acquisition in mice, and so is a high fat diet.”
Obesity “Interviewer 1: What is your perspective on the sugar sweetened
beverage tax?
Intevriewee 1: Is generally in support of this idea, it could be
effective in bringing down rates of obesity in the population.”

Sugar Sweetened “Interviewer 1: What is your perspective on the sugar sweetened

Beverage Tax beverage tax?
Intevriewee 1: Is generally in support of this idea, it could be
effective in bringing down rates of obesity in the population.”

Portion Sizes “Interviewer 1: What is your perspective on the portion sizes in the
U.S and do you think there are differences somewhere else?
Interviewee 1: Portion sizes are huge! I am not sure how effective
policing portion sizes at restaurants could be, but they’re definitely a
cultural problem in this country.”

Food Systems “Portion sizes are huge! I am not sure how effective policing portion
sizes at restaurants could be, but they’re definitely a cultural problem
in this country.”

Research “Interviewer 1: What other organizations, teams, or individuals do

you work with directly related to nutrition, and outside of nutrition?
Interviewee 1: There are not really any that are directly related to
nutrition, though it is commonly an aspect of the work we do together
in research.”
 Policy “Interviewee 1: We have to navigate around issues with IACUC
(institutional animal care and use committee) for our mouse model
studies, and IRB when working with humans. Generally, we do not
run into problems with these policies as we follow the standards
required to get approved.”

Key Informant 2 CODE: Lissa Goldstein

(Owner of Wild Work Farm)
Interviewer: Corinn Bryant

Codes Transcript Text

Job Role “I'm sure well my role is that i'm the owner of the business, so I am
responsible for all the business side of things, so all the finances all the
hiring all that stuff and then i'm also kind of like the manager of the farm
itself so training. Just kind of getting things done.”

Teams “I am responsible for all the business side of things, so all the finances
all the hiring all that stuff and then i'm also kind of like the manager of the
farm itself so training. Just kind of getting things done, but I have more
and more employees who are capable of those things too, and then our
farm.”

Organization “our farm, mostly grows food for very local community. We sell food to
Purpose our local community so we're like a very localized farm within our you
know I wouldn't say, like most people are getting sound like most people
are getting the bulk of their food from us, but. You know, we provide fruit,
fruit and veggies to like I mean we have 150 CSA members and then all
the other families”

Nutritious Food “You know, we provide fruit, fruit and veggies to like I mean we have 150
CSA members and then all the other families, and so you know in
season, I would say, like there's a decent number of local people that are
getting you know, the majority of their veggies from us.”
Not Nutritious “yeah I mean I, the main thing I think is just like how many processed
Food foods we eat, so how much just like.You know, we don't have enough
time for cooking so people are buying a lot of convenience foods, a lot of
frozen foods, a lot of prepared foods, and I think just those have like a lot
of artificial ingredients in them and then more probably more salt and fat.
Which i'm not against salt and fat, but I think that they're just like not as
many redeeming qualities.”

Partnerships “Only one we work with is WIC, which is the women infant and children
nutrition coupons and then there's the seniors one to that we work with…
and outside of that it's pretty much just like occasional contact with food
shelves…there's like a nonprofit here that works, a little bit with like food
act on food access.”

Westernized Diet “Interviewer 2: What are the most concerning challenges of the impact
of a Westernized diet on chronic disease. That you can see, or or like
just from your perspective.
Interviewee 2: yeah I mean I, the main thing I think is just like how
many processed foods we eat, so how much just like.”

Sugar
Sweetened “Interviewer 2: What is your perspective on the sugar sweetened
Beverage Tax beverage tax? Do they have that in New York?
Interviewee 2: I don't know, but I think that's a great idea yeah I mean, I
think that, like, I mean I don't you know I mean I don't think there's
anything. wrong with having a drink, you know soda now and then, but
like. If there's a tax, you know, maybe it would incentivize people not to
like go to that as they're like first choice or not to be drinking, you know
drink more water less coke you know that kind of thing so yeah I mean.”
Policy “Oh policies. Not like super direct, not that I know of super directly, I
would say, like probably just like the way, politics is and, like the fact
that, like more money goes to big AG, which then feeds into these
processed foods and then there's a less subsidies and like money going
to small like or, or other veggie funds which.”

International “Well, in East Africa the diet is like pretty limited like there's definitely
Eating pattern less processed foods, unless you have money and you live in a city,
otherwise it's like corn and beans and like maybe some meat and the
portion sizes are big but, the foods are less fatty. They're not processed
and people aren't snacking as much it's kind of like they have like two
bigger meals and breakfast is usually pretty light. And then in Canada, I
do think the portion sizes, probably in general are smaller but like there's
still like where Steve from Alberta, where everyone like eats like a
massive steak you know and there's still those restaurants, that have
kind of like American style portions. But I think again like I think
Americans are more, I think we're like I think our processed food snack
food lobby is like stronger.”

Meals “I think so anymore it's like more culturally than like the physicality of the
food too it's like we don't we're not always good at having mealtime. it's
like I know so many people that like don't eat meals or don't or like. yeah
just don't I don't know like to stay in think we just don't necessarily like
not the three meals, a day is the answer, but I just think like we don't
always give eating the time it needs.”

Portion Size “And then in Canada, I do think the portion sizes, probably in general are
smaller but like there's still like where Steve from Alberta, where
 everyone like eats like a massive steak you know and there's still those
restaurants, that have kind of like American style portions.”

Obesity “When I you know, like 10 years ago, or whatever, like a lot of this stuff
was like Oh, people are obese kids are too fat everyone's obese, and
now i'm noticing there's also this like kind of parallel perpendicular thing
happening, which is that, like. it's not necessarily right to like shame
people you know by are you getting that in school? yeah positivity and
like that.”

Body Size/Weight “yeah health is one thing, but also just like some people are fat, some
Stigma people are thin like different body sizes is not always an indicator of
health or bad health or bad, and that you know it doesn't mean you're
like a bad person, so I think it's like kind of getting into tough territory to
be like policing these things I guess it's just like hard to say it's like hard
to make a general statement about it.”

Food Systems “If there's a tax, you know, maybe it would incentivize people not to like
go to that as they're like first choice or not to be drinking, you know drink
more water less coke you know that kind of thing so yeah I mean… Why
not be taxed cigarettes, we tax alcohol, I think I mean just seems like a
good idea. It’s a cost to the Food system.”

Food Access “finding ways around the prevalence of like processed foods mainly just
making our foods more . getting them in as many places as possible,
making sure there's no barriers for people to be getting them that kind of
thing.
Interviewer 2: mm hmm.
Interviewee 2: So like having fruit, vegetables in like Stewart you know
the gas station that could be that's something I had thought about.”
Funding “which then feeds into these processed foods and then there's a less
subsidies and like money going to small like or, or other veggie funds
which. Then would, could potentially… if as much emphasis and power
was put on like vegetable farms, as it is until like commodities and like
these industries and then yeah and I suppose that that would probably
affect like health.”

Thematic Analysis
Theme Codes Exemplary Quote

Organization “our farm, mostly grows food for very

Characteristics local community. We sell food to our
local community so we're like a very
● Job Role localized farm within our you know I
● Organization Purpose wouldn't say, like most people are
● Teams getting sound like most people are
getting the bulk of their food from us,
● Partnerships but. You know, we provide fruit, fruit
● Research and veggies to like I mean we have
150 CSA members and then all the
other families” - Key Informant 2

Nutrition “Interviewer 1: What is your

● Meals
● Portion Size
● Nutritious food
● Not nutritious food
perspective on the portion sizes in the
U.S and do you think there are
differences somewhere else?
Interviewee 1: Portion sizes are
huge! I am not sure how effective
policing portion sizes at restaurants
could be, but they’re definitely a
cultural problem in this country.” - Key
Informant 1
US Food System “Interviewer 2: What is your
● Sugar Sweetened perspective on the sugar sweetened
Beverage Tax beverage tax? Do they have that in
● Food Access New York?
● Funding Interviewee 2: I don't know, but I
● Policy think that's a great idea yeah I mean, I
think that, like, I mean I don't you
know I mean I don't think there's
anything. wrong with having a drink,
you know soda now and then, but like.
If there's a tax, you know, maybe it
would incentivize people not to like go
to that as they're like first choice or
not to be drinking, you know drink
more water less coke you know that
kind of thing so yeah I mean.” - Key
Informant 2

International “Well, in East Africa the diet is like

Characteristics pretty limited like there's definitely
and Cultures less processed foods, unless you
● International Eating have money and you live in a city,
Pattern otherwise it's like corn and beans and
● Food Systems like maybe some meat and the portion
sizes are big but, the foods are less
● Westernized Diet fatty. They're not processed and
people aren't snacking as much it's
kind of like they have like two bigger
meals and breakfast is usually pretty
light. And then in Canada, I do think
the portion sizes, probably in general
are smaller but like there's still like
where Steve from Alberta, where
everyone like eats like a massive
steak you know and there's still those
restaurants, that have kind of like
American style portions. But I think
again like I think Americans are more,
I think we're like I think our processed
food snack food lobby is like
stronger.” - Key Informant 2

Health Outcomes ““Obesity and metabolic disease are

● Obesity both seen to decrease skeletal
acquisition in mice, and so is a high
 ● Body Size fat diet.” - Key Informant 1
● Health

Key Informant Interview Guide

INTRODUCTION: say who you are/your affiliation; give a concise summary of the
interview purpose. [3 mins]

Interviewer 1: Hello, as you know my name is _____. I am a student at the University

of Michigan in the_________. I am collecting information for a class project focused on
engaging cross-sector partners to address public health challenges. Our team is
focusing on looking at a global perspective of nutrition leading to chronic diseases, and
more specifically how a westernized diet relates to this. Thank you for meeting with us
today.

Interviewer 1: We are aiming for this interview to take no more than 20 minutes. We’re
interested in your perspectives regarding the global perspective of nutrition leading to
chronic diseases, and more specifically how a westernized diet relates to this concept.
During this face-to-face interview, I will be taking notes to record your responses. Is that
okay?

Get verbal consent for participation: If you plan to audio/video record the interview, ask
for permission here. “We’d like to record this session to ensure we accurately capture
your perspectives. Is it okay with you if we record the interview?” or permission to take
notes

Interviewee background information [3 mins]

Interviewees: Maureen Devlin and Lissa Goldstein

1. To start, would you please describe your/your organization’s role in a, b.

a. Interviewee Lissa: describe your role in WWF and your organization's role
within the food system.
 b. Interviewee Maureen: describe your role at UM and what your work
focuses on
1. Do you work with a team as part of this role?

Key Topic 1: The Public Health Challenge Your Team Defined [4 mins]

2. What are the most concerning challenges of the impact of a westernized diet on
chronic disease development?

Key Topic 2: An Intervention or Action[4 mins]

3. What is your perspective on the sugar-sweetened beverage tax?

4. What is your perspective on the portion sizes in the U.S?
1. Differences somewhere else?

Key Topic 3: stakeholders and partnerships [2 mins]

5. What other organizations/teams/individuals do you work with directly related to

nutrition, and outside of nutrition?
1. Are there any international partners?
2. Are there partnerships you would like to form?
3. Are there barriers to forming needed partnerships?

Key Topic 4: governance/power/authority [3 mins]

6. When we think about cross-sector partnerships, issues of governance, power, or

authority might come into play.
Are there policies or regulations that you have to work within that make it harder
to complete your work and mission in regards to nutrition and chronic disease?
How do you navigate this tension?

Key Topic 5: interprofessional practice [3 mins]

7. Interprofessional practice principles include values and ethics,

roles/responsibilities, teams and teamwork, and communication. Which of these
principles do you think are most important for working in teams to address the
impact that nutrition has on the development of chronic disease?

CLOSING: thank the interviewee and close the meeting. [2 mins]

Interviewer 1: You’ve answered our questions. Thank you very much for your time and
for sharing your insights with us.
Do you have any additional comments about … that we haven’t yet covered?
Again, thank you very much, and have a great day.