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The Treatwell 5-a-Day Study. Hebert JR, Peterson KE, Hurley TG, Stoddard AM, Cohen N, Field AE, Sorensen G. The effect of social desirability trait on self-reported dietary measures among multi-ethnic female health center employees. Ann Epidemiol 2001; 11:417-427.

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slide1

The Treatwell 5-a-Day Study

Hebert JR, Peterson KE, Hurley TG, Stoddard AM, Cohen N, Field AE, Sorensen G. The effect of social desirability trait on self-reported dietary measures among multi-ethnic female health center employees. Ann Epidemiol 2001; 11:417-427.

  • Multi-ethnic sample of community health center

workers

  • Representing three control sites
  • Multiple 24HR as “relative criterion”
  • Uses three methods for comparison, including

Harvard/Channing FFQ

  • Predominantly (~85% women)
slide2

The Treatwell 5-a-Day Study – Social Desirability Results by Ethnicity, Women Only

Black

Hispanic

White

(n=23)

(n=31)

(n=30)

Variable:

b

SEb

b

SEb

b

SEb

Total Energy Intake (kcal/d)

15.1

31.1

18.9

20.0

-4.5

15.9

Total Fat Intake (g/d)

0.64

0.94

1.03

1.07

-0.23

0.62

slide3

The Treatwell 5-a-Day Study – Results by

Occupational Category, Women Only

Non-Professional

Professional

p-value for

(n=52)

(n=39)

Ho:

b<coll=b>coll

Variable:

b

SEb

b

SEb

Total Energy Intake (kcal/d)

31.8

18.5

-20.6

14.5

<0.005

0.57

Total Fat Intake (g/d)

1.12

0.67

-0.19

<0.05

ns

0.037

Fruit (servings/d) - FFQ

0.011

0.042

-0.004

Fruit (servings/1000kcal/d)

-0.008

0.031

0.002

0.029

ns

slide4

The Treatwell 5-a-Day Study – Results by

Education, Women Only

College Degree

or More

p-value for

Less Than College

(n=52)

H o:

b<coll=b>coll

(n=39)

Variable:

b

SEb

b

SEb

Total Energy Intake (kcal/d)

36.1

20.0

-23.6

12.8

<0.001

Total Fat Intake (g/d)

1.23

0.78

-0.50

0.41

<0.001

Fruit (servings/d) - FFQ

-0.003

0.046

-0.027

0.033

ns

Fruit (servings/1000kcal/d)

-0.005

0.032

-0.002

0.026

ns

slide5

The Treatwell 5-a-Day Study – Conclusions

The FFQ also appears to be biased by social

desirability in women, but …..

¨

the critical factor determining the bias is

education which is …..

¨

more important than occupational category or

ethnicity/race.

¨

As in the WATCH study, bias is oriented toward

fat/energy intake

¨

slide6

The Energy Study, Worcester, MA - 1997

Hebert JR, Ebbeling CB, Matthews CE, Ma Y, Clemow L, Hurley TG, Druker S. Systematic errors in middle-aged women's estimates of energy intake: Comparing three self-report measures to total energy expenditure from doubly labeled water. Ann Epidemiol 2001; (In Press):00-000.

¨

First such study to focus on the most widely

used FFQ (NCI/WHI)

¨

First study to focus on these biases employing

stable isotope methods for comparison

(TEE from DLW)

slide7

Overview of Study

Doubly-Labeled Water Metabolic Period

7

14

0

1

days

  • Baseline questionnaires
  • Demographic data
  • (education)
  • Social desirability (Marlowe-Crowne Scale, 33-item, true/false)
  • Food frequency questionnaire
  • (WHI)
slide8

Description of the Study Population,

The Energy Study (N=73)

n

%

Married

47

64.4

White

72

98.6

Pre-menopausal

41

56.2

Bachelors Degree or more

33

45.2

Employed Full Time

44

60.3

Professional, Managerial Work

33

55.0

Current Smoker

7

9.6

Sedentary

38

52.1

slide9

Further description of the Study Population,

The Energy Study (N=73)

Interquartile

Range

Mean

Standard

Deviation

Minimum

25%

75%

Maximum

Age

(years)

49.0

6.8

40

44

53

65

Body Mass (kg)

70.0

10.4

43.9

62.1

76.9

90.5

BMI (kg/m2)

27.1

4.1

18.7

24.5

29.8

38.2

Fat-Free Mass (kg)

42.4

5.1

32.3

38.1

46.3

53.7

Social Desirability

Score

17.4

5.9

4.0

15.0

22.0

29.0

slide10

Further description of the Study Population,

The Energy Study (N=73)

Interquartile

Range

Mean

Standard

Deviation

Minimum

25%

75%

Maximum

380

1378

1830

2318

3337

TEE from DLW (kcal/d)

2102

24-Hour Recall-Derived

Data (7-day average)

Energy Intake (kcal/d)

1820

464

1147

1494

2002

3566

Food Quotient

0.90

0.03

0.82

0.88

0.92

0.99

FFQ Energy (kcal/d)

Day-0 Administration

1735

764

429

1229

2089

4986

Day-14 Administration

1622

594

639

1186

2028

3703

slide11

Social Desirability Bias (kcal/day/point) by Education

Level (FFQ-Derived Energy Intake Versus TEE from

DLW, Beginning of Metabolic Period), The Energy Study (N=73).

All Education Levels:

Whole Sample (n=73)

-36.6 (-65.7, -7.5)

Excluding “Outliers ” (n=69)

-12.2 (-34.7, 13.1)

High Education (college +)

Whole Sample (n=33)

-73.3 (-113., -32.9)

Excluding “Outliers ” (n=31)

-31.9 (-63.6, -0.2)

slide12

Social Desirability Bias (kcal/day/point) by Education Level (FFQ-Derived Energy Intake Versus TEEfrom DLW, End of Metabolic Period), The Energy Study (N=73).

All Education Levels:

Whole Sample (n=73)

-10.8 (-34.7, 13.1)

Excluding “Outliers ” (n=72)

-13.7 (-35.8, 8.4)

High Education (college +)

Whole Sample (n=33)

-21.8 (-53.5, 9.9)

slide13

Social Desirability Bias

50

25

0

-25

Bias (kcal/day/point)

-50

-75

Beginning

-100

End

-125

-150

Education

Whole

Sample(n=75)

High

(n=33)

Low

(n=42)

slide14

Revisiting WATCH --- Why?

Hebert JR, Ma Y, Ebbeling CB, Matthews CE, Ockene IS. Self-report data. Compliance in Healthcare and Research. Armonk, NY: Futura, 2001:163-179.

Is there an effect of education when cut at

college+?

¨

What happens with these biases after an

intervention?

¨

slide15

Social Approval Bias in Males, by Education,

WATCH Study,

Worcester, Massachusetts, 1991-1995.

< College (n=150)

Social Approval

BMI

Score

Baseline

29.8 (0.003)

29.1 (0.07)

Total Energy (kcal/day)

1.60 (0.07)

Total Fat (g/day)

1.63 (0.004)

Total SFA (g/day)

0.59 (0.003)

0.53 (0.09)

One-year

< College (n=112)

Total Energy (kcal/day)

36.7 (0.0003)

53.4 (0.001)

Total Fat (g/day)

1.50 (0.004)

1.72 (0.04)

Total SFA (g/day)

0.41 (0.02)

0.57 (0.05)

slide16

Social Approval Bias in Males, by Education,

WATCH Study,

Worcester, Massachusetts, 1991-1995.

³ College (n=70)

Social Approval

BMI

Score

Baseline

Total Energy (kcal/day)

8.6 (0.49)

48.6 (0.05)

Total Fat (g/day)

0.58 (0.39)

3.87 (0.05)

Total SFA (g/day)

0.26 (0.26)

1.34 (0.07)

One-year

³ College (n=56)

Total Energy (kcal/day)

19.9 (0.14)

33.7 (0.14)

Total Fat (g/day)

1.05 (0.11)

0.70 (0.52)

Total SFA (g/day)

0.25 (0.18)

0.15 (0.63)

slide17

Social Approval and Social Desirability Bias

in Females, by Education, WATCH Study,

Worcester, Massachusetts, 1991-1995.

< College (n=220)

Social Approval

Social Desirability

Score

Score

BMI

Baseline

Total Energy (kcal/day)

-0.2 (0.97)

-14.8 (0.14)

6.9 (0.43)

Total Fat (g/day)

-0.02 (0.95)

-0.53 (0.34)

0.25 (0.61)

0.05 (0.75)

Total SFA (g/day)

0.03 (0.76)

-0.14 (0.45)

One-year

< College (n=172)

Total Energy (kcal/day)

11.0 (0.07)

-3.6 (0.77)

11.1 (0.32)

Total Fat (g/day)

0.36 (0.32)

-0.57 (0.43)

0.36 (0.58)

Total SFA (g/day)

0.14 (0.21)

-0.15 (0.52)

0.21 (0.32)

slide18

Social Approval and Social Desirability Bias

in Females, by Education, WATCH Study,

Worcester, Massachusetts, 1991-1995.

³ College (n=64)

Social Approval

Social Desirability

Score

Score

BMI

Baseline

Total Energy (kcal/day)

-2.9 (0.72)

-24.3 (0.04)

19.7 (0.11)

Total Fat (g/day)

-0.34 (0.49)

-1.28 (0.07)

1.42 (0.05)

Total SFA (g/day)

-0.10 (0.52)

-0.53 (0.01)

0.41 (0.07)

One-year

³ College (n=53)

Total Energy (kcal/day)

-5.1 (0.61)

-9.5 (0.54)

35.5 (0.04)

Total Fat (g/day)

-0.23 (0.67)

-0.21 (0.80)

1.98 (0.02)

Total SFA (g/day)

-0.06 (0.74)

-0.05 (0.86)

0.75 (0.01)

slide19

WATCH Study Conclusions:

Education modifies the effect of the social

desirability and social approval

¨

The effects differ by gender

¨

There appears to be a differential effect of the

intervention on the bias according to

gender and education

¨

slide20

The Role of Social Desirability in

Epidemiologic Confounding

SD Score

Psychologic

Predispositions

Physiologic

Responses

(e.g., Immune

Function)

Disease

True

Diet

Reported

Diet

slide21

WATCH Nutritionist Intervention:

Total Fat and Saturated Fat

Never Referred

< 3 Sessions

³ 3 Sessions

-0.71

-0.26

-4.95

-2.13

-8.24

-2.73

0

±0.14

-2

±0.38

±0.49

-4

±0.50

(% total energy)

Change in fat intake

-6

±1.36

-8

Total Fat

-10

Saturated Fat

±1.39

(n=645)

-12

slide22

WATCH Nutritionist Intervention:

Total Cholesterol and LDL

Never Referred

< 3 Sessions

³ 3 Sessions

0.01

0.15

±0.03

-0.02

-0.15

-0.13

-0.43

-0.48

0

±0.03

-0.15

Changes in serum cholesterol

(mmol/L)

±0.11

±0.12

-0.3

-0.45

TC

±0.13

-0.6

±0.11

LDL-C

-0.75

(n=555)

slide23

WATCH Nutritionist Intervention:

Actual Changes in Total Cholesterol vs. 7DDR - Predicted Values

0

-9.9

-8.4

-9.1

-1

-2

-3

-4

Change in Total Serum Cholesterol

(mg/dL)

-5

-6

-7

-8

-9

Keys

Prediction

Hegsted

Prediction

-10

Actual

slide24

Table 4. Effects of social desirability on self-reported and measured change scores, WATCH Study, Worcester, Massachusetts, 1991-1995.

*

Variable

P

b

Self-reported data

Fat intake (% energy)

-0.22

0.002

Body weight

-0.02

0.59

(kg)

Measured data

Serum LDL-C (mmol/L)

0.004

0.48

Body weight

0.02

0.59

(kg)

* P-value for the test of H0:=0