Using a Brief Household Food Inventory
as an Environmental Indicator of
Individual Dietary Practices
Ruth E. Patterson, PhD, RD, Alan R. Kristal, DrPH, Jackilen Shannon, PhD, RD,
Julie R. Hunt, PhD, and Emily White, PhD
Introduction
Community- or population-level nu-
trition interventions (public health inter-
ventions) are attractive approaches for
promoting desirable eating pattems.'"
These programs have the potential to
reach large numbers of people and can
encourage environmental changes that
may facilitate and sustain widespread
dietary behavior changes.
However, there have been few inno-
vations in the methods used to evaluate
community-based nutrition interventions.
Program effects are typically assessed at
the individual level by comparing the
dietary intake of residents of intervention
communities with that of residents of
control communities. While it may be
reasonable to assess clinical interventions
in terms of changes in nutrient intake,
simpler environmental measures may be
more appropriate for evaluating public
health studies.5
Environmental indicators of indi-
vidual dietary intake can provide useful
information on the ways in which health
promotion programs promote changes in
individual dietary intake.6 These mea-
sures can help test the underlying causal
model, detect early program effects, and
enhance an evaluation strategy in that the
results from one measurement approach
can be compared with results of other
approaches.7 At a practical level, collect-
ing data on environmental indicators is
simpler and less expensive than individual-
level assessments.
Our objective was to determine
whether a measure of the household
environment-the availability of high-fat
foods in the pantry-can provide an
altemative to individual-level dietary as-
sessment in community-based nutrition
studies. To accomplish this objective, we
examined associations between the num-
ber of high-fat foods in pantries and
several key factors related to food con-
sumption and dietary change in individu-
als: a demographic variable (household
composition), a dietary behavior (reading
food labels), a psychosocial construct (fat
stage of dietary change), and dietary
intake (percentage of energy from fat).
Methods
Sample
Study participants were 1002 adults
(18 years of age and older) residing in
Washington State. Survey data were
collected from June to September of 1992
as part of the Washington State Cancer
Risk Behavior Survey, a random-digit
dialing survey monitoring cancer risk
behavior. Details of our survey procedures
have been published.8
We made 15 attempts to contact an
individual in the first month of calling and
11 attempts 3 months later. When we
reached a household with at least one
adult, we asked the respondent (the
"household informant") to answer ques-
tions regarding the foods in his or her
pantry and to provide a household roster.
We then randomly selected a household
member for the individual survey. If
selected individuals were not available,
we made up to 5 additional attempts to
contact and survey them.
The conservatively estimated effec-
tiveness rate (completed interviews di-
vided by known eligibles and estimated
eligibles) for the household informant
survey was .70. The effectiveness rates for
the individual survey were .68 if the
respondent was the household informant
and .51 if the respondent was not the
household informant.
Measures
High-fat food in household pantries.
For this measure, we chose 15 foods
The authors are with the Cancer Prevention
Research Program, Fred Hutchinson Cancer
Research Center, Seattle, Wash.
Requests for reprints should be sent to Ruth
E. Patterson, PhD, RD, Cancer Prevention
Research Program, Fred Hutchinson Cancer
Research Center, 1124 Columbia, MP 702,
Seattle, WA 98104.
This paper was accepted May 17, 1996.
Editor's Note. See related annotation by
Cassano and Frongillo (p 157) in this issue.
February 1997, Vol. 87, No. 2
 Public Health Briefs

(Table 1) that are major contributors of

total fat in the US diet9 and have been TABLE 1-Percentage of Individual Respondents Eating High-Fat Foods,
useful indicator foods in other studies of by Whether the Food Was in Their Pantries (n = 1002)
diet and dietary change.8"1'2 For 6 foods
(hot dogs, bologna, or lunch meat; butter Consumption, %
or margarine; frozen desserts; cheese;
Households
with Food in Food Food Not
mayonnaise; and salad dressing), we Pantry Item Pantry, % in Pantry in Pantry
ascertained whether the food was a
reduced-fat product. To keep the survey 5 or more times per week
short and simple, we elected not to request Nuts or peanut buttera 88.6 23.8 6.1
detailed information on the fat content of Cheeseb,c 85.5 34.5 12.7
cuts of meat, cookies, snack chips, past- Beef, pork, lambc 77.6 26.2 8.5
ries, breakfast meats, or cakes and pies. Butter or margarinea,b 76.6 65.5 57.3
Cookiesc 46.7 32.7 8.6
We asked the household informant whether Whole milk 17.8 ... ...
the food was present in his or her pantry Skim or 1% milkcd 35.7 79.8 18.8
(we use the term "pantry" to include
foods in cabinets, refrigerators, and so At least once a week
forth). For "don't know" responses, we Potato, corn, or tortilla chipsc 55.0 71.5 27.7
asked informants to look for the food. Pastry (e.g., doughnut or sweet roll)c 9.2 51.1 22.9
Two individuals were still unable to verify
the presence (or absence) of 2 foods, and 6 No information on consumption
people were unable to verify the presence Bacon, sausage, and other breakfast meat 48.6 ... ...
of 1 food. In those instances, we assumed Mayonnaiseb 39.8 ... ...

that the food was not present.
We summed the number of high-fat
foods to provide a scale of availability of
high-fat foods for household members.
Reduced-fat products (e.g., nonfat mayon-
naise) were not included in the scale. The
number of high-fat foods ranged from 0 to
14; the mean (± SD) was 6.4 (±2.6), the
median was 6, and the mode was 7.
Fat intake of individuals. We as-
sessed percentage of energy from fat
using the Quick Dietary Screen. This
instrument consists of 16 questions about
whether a food is eaten daily, 28 questions
about whether a food is eaten at least
weekly, and 2 questions about frequency
of consumption of red meat and use of
butter or margarine on breads. We used
these data in age- and gender-specific
regression models to estimate dietary fat
intake. In a validation study, correlations
between a telephone-administered version
of the Quick Dietary Screen and two
4-day food records, a food frequency
questionnaire, and the average of the
records and the questionnaire were .54,
.65, and .65, respectively, for percentage
of energy from fat.'3
Other variables. To classify individu-
als in a stage of change for reducing fat
intake, we used a slight modification of
the algorithm developed and evaluated by
Curry et al.'4 We defined the maintenance
stage of dietary fat reduction as limiting
dietary fat for longer than 6 months and
the action stage as limiting fat for 6
months or less. People not limiting the fat
in their diet were classified as in one of
three stages: preparation (if they had
thought about making changes and planned
High-fat frozen desserts
Hot dogs, bologna, lunch meatb
Cakes and pies
Cream or whipped cream
aChi-square tests for distribution were statistically significant (P < .05).
bExcluding reduced-fat or nonfat products.
CChi-square tests for distribution were statistically significant (P < .001).
dNot included in the count of high-fat foods in household pantries.
to do so), contemplation (if they had only
thought about changes), or precontempla-
tion (if they had neither thought about nor
had plans to make dietary changes).
We also asked respondents how
often they read food labels for nutrition
information. Response options were (1)
almost always, (2) fairly often, (3) only
occasionally, and (4) never.
Statistical Analysis
We determined the percentage of
individual respondents eating high-fat
foods stratified by whether the food was,
or was not, in their pantry. We tested the
significance of these associations using
chi-square tests. We calculated means and
95% confidence intervals for the number
of high-fat foods by type of household,
respondents' use of food labels, and stage
of dietary change. Finally, we computed
correlation coefficients between indi-
vidual respondents' percentage of energy
from fat and the number of high-fat foods
in their pantry.
Results
The mean (+SD) age of the house-
hold informants was 44.9 (±16.6); 65%
26.8
21.0 ... ...
16.3 ... ...
12.1 ... ...
were female. The mean age of individual
respondents was 44.8 (± 16.8); 55.2%
were female, 91.2% were White, 29.8%
had a college education, and estimated fat
intake was 34.8% (±5.6%) energy from
fat.
More than 75% of household pan-
tries contained nuts or peanut butter,
cheese, red meats, or butter/margarine
(Table 1). Less than 25% of pantries
contained hot dogs, bologna, or lunch
meats; whole milk; cakes or pies; cream;
or pastries. Significantly more respon-
dents regularly consumed a high-fat food
if the food was in their pantry than if it
was not.
Single women had fewer high-fat
foods in their pantry than single men,
couples, or households with children
(Table 2). Individuals who read food
labels and were in later stages of change
(e.g., maintenance) were more likely
to live in households containing fewer
high-fat foods than individuals who
did not read food labels or were in
earlier stages of change (e.g., precontem-
plation).
As shown in Table 3, the correlation
coefficient between individuals' percent-
age of energy from fat and the number of

February 1997, Vol. 87, No. 2 American Journal of Public Health 273
Public Health Briefs

indicator of household members' diet

TABLE 2-Associations between Individual Respondents' Type of practices.
Household, Use of Food Labels, Stage of Dietary Change, and Two other studies have examined the
Number of High-Fat Foods in Their Pantry utility of measures of the household food
supply. Crocket et al.'5 compared a self-
High-Fat Foods in Housea reported shelf inventory with an inter-
95% Confidence viewer-completed, same-day inventory
No. Mean Interval and reported excellent validity (sensitivity
rates were 86% and 87% and specificity
Type of household rates were 92% and 90% in two investiga-
Single male 89 5.80 5.21, 6.39 tions). The authors also found that the
Single female 152 5.28 4.86, 5.70
349 6.26 5.99, 6.53 accuracy of the participant-reported food
-2 adults and no children
21 adult with children 412 6.98 6.76, 7.20 inventory did not vary by gender or by
Read labels for nutrition information responsibility for food shopping. Kendall
Almost always 268 5.40 5.10, 5.70 et al.16 surveyed 193 households in rural
Fairly often 225 6.13 5.80, 6.46 New York State and found that poor
Occasionally 303 6.79 6.53, 7.05 household food availability was signifi-
Never 203 7.26 6.90, 7.62 cantly associated with greater individual-
Fat stage of change level measures of food insecurity.
Precontemplation 216 7.38 7.06, 7.70 The major limitation associated with
Contemplation 68 7.63 7.13, 8.13
Preparation 65 6.43 5.84, 7.02 the use of household food supply is the
Action 177 6.22 5.86, 6.58 error involved in extrapolating informa-
Maintenance 476 5.77 5.54, 6.00 tion about household food availability to
aThe presence of 15 high-fat foods was assessed. individual dietary practices. For instance,
this measure does not capture information
about foods purchased and consumed
outside the home. In multiple-person
households, an inventory of household
TABLE 3-Correlations between Individual Respondents' Dietary Fat Intake foods will not reflect each household
(Percentage Energy from Fat) and Number of High-Fat Foods in member's diet with equal validity. It
Their Pantry, by Household Composition and Informant Status appears likely that households with chil-
dren contain high-fat foods purchased for
Correlation the children (e.g., whole milk, cookies)
No. Coefficient
that are not necessarily consumed by the
Entire sample 1002 .42* adults. Finally, it should be noted that
Single-person households 241 .46* household food inventory variables will
always be crude indicators of the key
.2 adults and no children 349 44* nutrients responsible for reducing cardio-
Respondent household informant 187 .55*
Respondent not household informant 162 .31 * vascular disease and cancer risk.
.1 adult with children 412 .30* A caveat to this study concems the
Respondent household informant 234 .42* use of a relatively brief assessment tool
Respondent not household informant 178 .13 (the Quick Dietary Screen) for estimating
fat intakes. More comprehensive meth-
Note. Household informants inventoried pantry contents. Individual respondents were ods, such as multiple-day food records or
randomly chosen from a household roster. food frequency questionnaires, would
*P< .001.
produce more precise estimates of dietary
intake.
In spite of the limitations, an inven-
tory of household foods has several
high-fat foods in their pantry was .42 Discussion important advantages: (1) It takes a short
(P < .001). Correlations between house- time to complete and has low respondent
hold foods and individual food intakes Individuals living in households burden; (2) it is less intrusive and
were higher in households with no chil- with fewer high-fat foods were more therefore may not be subject to the
dren than in households with children. In likely to be female, to read food labels, reactivity bias (e.g., social desirability) of
a regression model controlling for respon- to be at a later stage of dietary change, an assessment of individual eating behav-
dents' age, gender, self-rated health, edu- and to have lower fat diets than indi- ior; (3) it requires little skill, knowledge,
cation, and whether the respondent was viduals in households with more or training of respondents; and (4) it is
the household informant, individuals with high-fat foods. These data indicate that simple to administer and to analyze.
four or fewer high-fat foods in their pantry individual demographic and dietary char- A household measure such as a food
had a mean intake of 32% energy from fat, acteristics vary as expected with the inventory has a special advantage for
as compared with 37% for individuals healthfulness of the household food sup- random-digit dialing surveys. These sur-
with eight or more high-fat foods in the ply and support the criterion validity of veys require a household census followed
pantry (data not shown). the household food inventory as an by a sampling procedure such that each

274 American Journal of Public Health February 1997, Vol. 87, No. 2

individual in the household has an equal
probability of selection. Unfortunately,
this procedure also results in lower
response rates because the individual
selected may refuse to be interviewed.
Conversely, information on household
foods can be collected from any adult who
answers the phone, resulting in higher
response rates and lower probability of
nonresponse bias.
If environmental measures are to be
integrated into community-based nutri-
tion programs, their reliability, validity,
and responsiveness must be assessed. We
encourage investigators to consider supple-
menting surveys of individual food intake
with assessments of household food avail-
ability, both to provide additional mea-
sures of program effects and to further
investigate the validity of this mea-
sure. El
Acknowledgments
This research was supported by grants PO1
CA-34847 (Cancer Prevention Research Pro-
gram) and ROI (Cancer Control Surveillance
and Investigation System) from the National
Cancer Institute.
References
1. Fortmann SP, Flora JA, Windleby MA,
Schooler C, Taylor B, Farquhar JW.
February 1997, Vol. 87, No. 2
Community intervention trials: reflections
on the Stanford five-city project experi-
ence. Am J Epidemiol. 1995;142:576-586.
2. Luepker RV, Murray DM, Jacobs DR, et al.
Community education for cardiovascular
disease prevention: risk factor changes in
the Minnesota Heart Health Program. Am J
Public Health. 1994;84: 138 1-1393.
3. Shea S, Basch CE. A review of five major
community-based cardiovascular disease
prevention programs. I. Rationale, design,
and theoretical framework. Am J Health
Promotion. 1990;4:203-213.
4. Puska P, Nissinen A, Tuomilehto J, et al.
The community-based strategy to prevent
coronary heart disease: conclusions from
the ten years of the North Karelia project.
Annu Rev Public Health. 1985;6:147-193.
5. Kristal AR. Nutritional intervention: how
can we meet the "Healthy People 2000"
goals? Med Exerc Nutr Health. 1993;2:
3-4.
6. Koepsell TD, Wagner EH, Cheadle AC, et
al. Selected methodological issues in evalu-
ating community-based health promotion
and disease prevention programs. Annu
Rev Public Health. 1992;13:31-57.
7. Cheadle A, Psaty BM, Curry S, et al.
Community-level comparisons between the
grocery store environment and individual
dietary practices. Prev Med. 1991 ;20:250-
261.
8. Patterson RE, Kristal AR, White E. Do
beliefs, knowledge, and perceived norms
about diet and cancer predict dietary
change? Am J Public Health. 1996;86:
1394-1400.
Public Health Briefs
9. Block G, Dresser CM, Hartman AM,
Carroll MD. Nutrient sources in the Ameri-
can diet: quantitative data from the
NHANES H survey. Am J Epidemiol.
1985;122:27-40.
10. White E, Henderson MM, Hurlich M, et al.
Dietary changes among husbands ofpartici-
pants in a low-fat dietary intervention. Am
JPrev Med. 1991;7:319-325.
11. Shattuck AL, White E, Kristal AR. How
women's adopted low-fat diets affect their
husbands. Am J Public Health. 1992;82:
1244-1250.
12. Patterson RE, Kristal AR, Lynch JC, White
E. Diet-cancer related beliefs, knowledge,
norms, and their relationship to healthful
diets. J Nutr Educ. 1995;27:86-92.
13. Kristal AR, Shattuck AL, Henry HJ,
Fowler AS. Rapid assessment of dietary
intake of fat, fiber, and saturated fat:
validity of an instrument suitable for
community intervention research and nutri-
tional surveillance. Am J Health Promo-
tion. 1990;4:288-295.
14. Curry SJ, Kristal AR, Bowen DJ. An
application of the stage model of behavior
change to dietary fat reduction. Health
Educ Res. 1992;7:97-105.
15. Crocket SJ, Potter JD, Wright MS, Bach-
eller A. Validation of a self-reported
shelf inventory to measure food purchase
behavior. J Am Diet Assoc. 1992;92:694-
697.
16. Kendall A, Olson CM, Frongillo EA.
Validation of the Radimer/Cornell mea-
sures of hunger and food insecurity. J Nutr
1995; 125:2793-2801.
American Joumal of Public Health 275