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Extensive evidence has demonstrated that 24-hour dietary recalls (24HDRs) provide high-quality dietary intake data with minimal bias, making them the preferred tool for monitoring the diets of populations and, increasingly, for studying diet and disease associations (1-3). Traditional 24HDRs, however, are expensive and impractical for large-scale research because they rely on trained interviewers, and multiple administrations are needed to estimate usual intakes. To address these challenges, the National Cancer Institute (NCI), in collaboration with the research firm Westat (Rockville, MD), and with the support of other institutes and offices at the National Institutes of Health, developed the Automated Self-Administered 24-hour dietary recall (ASA24) (4-6). ASA24 is a public-access, freely available, web-based tool for researchers, clinicians and educators, modeled on the Automated Multiple Pass Method (AMPM) (7). Development of an automated self-administered 24HDR for adults began in 2006 and was informed by input from stakeholders participating in an External Working Group and small-scale cognitive and usability testing (4,5). A Beta version released in August 2009 has been used by over 175 researchers to collect over 40,000 recalls; Version 1, which offers improved usability and new features, was released in September 2011 (8). A modified version intended for self-administration by children is under development by researchers at the Baylor College of Medicine (Houston, TX) and is expected to be available mid-2012 (9,10). This paper describes the features of ASA24 and planned evaluations.
ASA24 is composed of two web-based applications, the Respondent and Researcher Websites. The Respondent Website is used by participants to complete recalls. The Researcher Website is used by researchers, clinicians, or educators to register, configure, and monitor studies. The Researcher Website also provides access to nutrient and food group analyses. Both sites require high-speed internet connections and standard computer monitors (not including netbooks or mobile phones) and are compatible with common internet browsers. Figure 1 presents the major functionality of, and interaction between, the Respondent and Researcher Websites.
The ASA24 Respondent Website guides the participant through the completion of a 24HDR for the previous day, from midnight to midnight, using a dynamic user interface. The Version 1 Respondent Website flows as per a modified AMPM 24HDR (Table 1), includes an animated guide (a penguin character/avatar) and audio and visual cues to instruct participants, with options to turn off the guide or the audio; asks respondents to report eating occasions and time of consumption; includes optional modules to query where meals were eaten, whether meals were eaten alone or with others, and television and computer use during meals; allows respondents to report foods and drinks by browsing a food category or searching from a list of food and drink terms derived from the 2007-08 National Health and Nutrition Examination Survey (11); allows the respondent to add or modify food and drink choices at multiple points during the session; asks detailed questions about food preparation, portion size, and additions so that food codes from the Food and Nutrient Database for Dietary Surveys version 4.1 (7) can be assigned; uses images taken at the Children's Nutrition Research Center of Baylor College of Medicine (Houston, TX) to assist respondents in reporting portion size; includes an optional module to query dietary supplement intake based on supplements reported in the 2007-08 National Health and Nutrition Examination Survey (12); is available in English and Spanish; and is accessible by individuals with disabilities. The Respondent Website does not provide feedback to respondents. Researchers obtain analysis files through the Researcher Website, and may contact respondents to communicate findings.
The Researcher Website allows researchers, clinicians, and educators to register to use ASA24, manage the logistics of data collection, and obtain analysis files. Users can obtain a variety of reports, including statistics for complete, incomplete, and upcoming recalls for each participant. Upon request, the website produces data files with individual-level nutrients and food group estimates based on the Food and Nutrient Database for Dietary Surveys version 4.1 (7), the corresponding MyPyramid Equivalents Database from USDA (13), and the 2007-08 National Health and Nutrition Examination Survey Dietary Supplement Database (12).
ASA24 is based upon the USDA Automated Multiple-Pass Method (AMPM), which has been validated and shown to accurately estimate mean total energy and protein intakes compared to recovery biomarkers (1,3). Preliminary examination of output from recalls completed using ASA24 suggests acceptable face validity (i.e., energy, nutrient, and food group estimates that are consistent with data from the National Health and Nutrition Examination Survey. To formally evaluate the impact of the change in mode of administration from the interviewer-administered AMPM 24-hour recall to a self-administered web-based recall, two studies will be conducted in 2012 using Version 1 of ASA24. In a study of 1000 healthy adults, 20-70 years of age, drawn from a variety of geographic regions, nutrient and food group estimates from ASA24 will be compared to those from standardized AMPM interviewer-administered recalls. In a second study, 80 adults, 20-70 years of age, will be randomly assigned to complete an ASA24 or AMPM recall one day after consuming foods of known amounts; each method will be validated against true intakes.
Adaptation of the interviewer-administered 24HDR to a fully-automated tool has the potential to revolutionize dietary assessment by enhancing the feasibility and cost-effectiveness of collection of high-quality dietary data. AS24 is now freely available for use by researchers, clinicians and educators and is in use in numerous studies in the US. Future experience and evaluation will reveal its most appropriate uses. Additional information regarding ASA24 can be found on its website (8).
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Amy F. Subar, National Cancer Institute, Division of Cancer Control and Population Sciences, Applied Research Program, Risk Factor Monitoring and Methods Branch, 6130 Executive Boulevard, EPN 4005, Bethesda, MD 20892-7344, Phone: 301-594-0831, Fax: 301-435-3710.
Sharon I. Kirkpatrick, National Cancer Institute, Division of Cancer Control and Population Sciences, Applied Research Program, Risk Factor Monitoring and Methods Branch, 6130 Executive Boulevard, EPN 4005, Bethesda, MD 20892-7344, Phone: 301-435-1638, Fax: 301-435-3710.
Beth Mittl, Westat, 1650 Research Blvd., Rockville, MD 20850, Phone: 301-251-4215, Fax: 301-294-2040.
Thea Palmer Zimmerman, Westat, 2311 Saybrook Road, Cleveland, OH 44118-3707, Phone: 216-397-6963.
Frances E. Thompson, National Cancer Institute, Division of Cancer Control and Population Sciences, Applied Research Program, Risk Factor Monitoring and Methods Branch, 6130 Executive Boulevard, EPN 4005, Bethesda, MD 20892-7344, Phone: 301-435-4410, Fax: 301-435-3710.
Christopher Bingley, Westat, 1650 Research Blvd., Rockville, MD 20850, Phone: 301-279-4569, Fax: 301-294-2040.
Gordon Willis, National Cancer Institute, Division of Cancer Control and Population Sciences, Applied Research Program 6130 Executive Boulevard EPN 4005, Bethesda, MD 20892-7344 Phone: 301-594-6652 Fax: 301-435-3710.
Noemi G Islam, Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Street, B3014, Houston, TX, 77031, Phone: 713-798-7037, Fax: 713-798-0514.
Tom Baranowski, Baylor College of Medicine, US Department of Agriculture/Agricultural Research Service, Children's Nutrition Research Center, 1100 Bates Street, Houston, TX 77030 Phone: 713-798-6762 Fax: 713-798-7098.
Suzanne McNutt, Westat, 3949Viewcrest Dr., Salt Lake City, UT 84124, Phone: 801-453-9268, Fax: 80) 453-9269.
Nancy Potischman, National Cancer Institute, Division of Cancer Control and Population Sciences, Applied Research Program, 6130 Executive Boulevard, EPN 4005, Bethesda, MD 20892-7344, Phone: 301-594-6573, Fax: 301-435-3710.