Identification and classification of consumer food-handling behaviors for food safety education.

OBJECTIVE: To identify key behaviors associated with major food safety pathogen control factors. DESIGN: World Wide Web-based descriptive study with 4 tasks: compile a list of food-handling behaviors from the literature; use Delphi process to build consensus, rank order, and edit lists of behaviors; assess content and construct validity; and review results of Delphi process at a summit meeting of selected experts to make final recommendations for a food safety behavior list. SUBJECTS/SETTING: A convenience sample of 10 epidemiologists, 11 food microbiologists, 10 food safety educators, and 10 food safety policy makers was recruited from lists of nationally known experts. Twenty-four experts completed 4 rounds of surveys presented to them via a Web site. Six experts attended a face-to-face meeting to finalize behavior lists. Statistical analyses performed Descriptive statistics and sum of observation data were used to determine rank order and validity. RESULTS: Twenty-nine key food-handling behaviors for maintaining the safety of food and reducing the number of cases and outbreaks of foodborne illness were identified. These were rank-ordered within 5 pathogen control factors: practice personal hygiene, cook foods adequately, avoid cross-contamination, keep foods at safe temperatures, and avoid foods from unsafe sources. APPLICATIONS/CONCLUSIONS: This list of rank-ordered behaviors grouped by pathogen control factor should help dietitians and educators confidently teach food safety guidance that will be most effective in preventing illness.

Food safety education: what should we be teaching to consumers?

Food safety education is most effective when messages are targeted toward changing behaviors most likely to result in foodborne illness. The five major control factors for pathogens are personal hygiene, adequate cooking, avoiding cross-contamination, keeping food at safe temperatures, and avoiding foods from unsafe sources. Pathogens associated with poor personal hygiene have the highest incidence and costs. Inadequate cooking and cross-contamination have lower incidence. Keeping food at safe temperatures and unsafe food sources have the lowest incidence, although costs per case are sometimes very high. We recommend that consumer food safety educators primarily focus on hand washing, adequate cooking, and avoiding cross-contamination. Secondary messages should focus on keeping food at safe temperatures and avoiding food from an unsafe source. Evaluation tools are needed to evaluate self-reported behavior changes. The evaluation questions must focus on salient behaviors that are most likely to result in foodborne illnesses and must withstand rigorous standards of reliability and validity.

Evaluation of food safety education for consumers.

Traditionally, nutrition educators have used a fairly global approach to teach food safety by teaching a broad range of safe food handling behaviors in the expectation that this will lead to the avoidance of foodborne illness. This approach can be confusing and lead to evaluation data that are difficult to interpret. This article suggests that food safety education and evaluation in the future be organized around five behavioral constructs: practice personal hygiene, cook foods adequately, avoid cross-contamination, keep foods at safe temperatures, and avoid food from unsafe sources. These five constructs are derived from data on actual outbreaks and estimated incidences of foodborne illness. Research is needed to establish reliable and valid evaluation measures for these five behavioral constructs. Evaluation instruments can be tailored to fit specific education programs. If evaluation instruments focus on these five behavior areas, the result will be meaningful evaluation data that can be more easily summarized across food safety education programs for consumers.

Use of nonvitamin, nonmineral dietary supplements among college students.

The authors assessed the use of nonvitamin, nonmineral (NVNM) dietary supplements in a college population. They found that the use of NVNM dietary supplements among college students might be higher than that of other population groups and that the types of NVNM products they use differ from those used by an older population. Of the 272 students who completed the questionnaire, 48.5% reported they took an NVNM supplement during the past 12 months. The most frequently used NVNM products were echinacea, ginseng, and St John's wort. Of the 27 students who took NVNM products to promote weight loss, 81.5% had body mass index (BMI) values in the acceptable range. Eleven of the 19 participants who reported an adverse reaction to an NVNM supplement continued to take the products despite negative effects. Users and nonusers of NVNM supplements did not differ significantly by age, ethnicity, gender, perceived dietary adequacy, or by exercise patterns.

The Abuela Project: safe cheese workshops to reduce the incidence of Salmonella typhimurium from consumption of raw-milk fresh cheese.

OBJECTIVES: A multiagency intervention was implemented in Yakima County, Wash, to reduce the incidence of Salmonella serotype Typhimurium infections resulting from eating queso fresco (fresh cheese) made from raw milk, a traditional food in the Hispanic diet. METHODS: A pasteurized-milk queso fresco recipe with taste and texture acceptable to the Hispanic community was developed. Trained Hispanic volunteers conducted safe cheese workshops, which were attended by more than 225 persons. RESULTS: Workshop participants' acceptance of the new recipe was excellent and positive behavior changes were maintained over 6 months. CONCLUSIONS: Educational interventions in Hispanic communities can reduce the incidence of Salmonella Typhimurium associated with eating queso fresco.

Diabetes educators' perspectives on barriers for patients and educators in diabetes education.

PURPOSE: This study assessed diabetes educators' perspectives on barriers that potentially affect patient access to and utilization of diabetes education. METHODS: A 40-item questionnaire was developed to collect needs assessment data on diabetes education programs. The questionnaire was mailed to a Washington State professional practice group in diabetes education (N = 143). RESULTS: Most respondents were registered nurses (61%) or registered dietitians (27%); 74% were certified diabetes educators. The educators' perceptions of the difficulty that type 1 versus type 2 patients experience in different areas of self-management after diabetes education underscored the importance of learning effective long-term skills for self-care. Some of the reasons given for type 2 patients dropping out of diabetes education programs were also cited as barriers to conducting follow-up, such as education being a low priority for the patient and the patient not being able to afford diabetes care services. CONCLUSIONS: Educators appeared to relate many patient barriers to a lack of patient understanding of the evolving nature of diabetes and the subsequent need for educational support. The role of continuing education for all patients needs to be emphasized to the patient during the initial education, as well as to the healthcare community and the patient's support network.

Determination of habitual alcohol intake from a panel of blood chemistries.

Combinations of automated blood tests were used to screen for level of alcohol consumption through the use of quadratic discriminant analysis. When 15 variables were used, quadratic discriminant analysis correctly placed 91% of persons who reported consumption of less than or greater than four drinks per day (48 g of ethanol). When alcohol intake of greater than or less than 24 g ethanol per day was used as the division point, 86% of persons were correctly placed. As the number of blood tests in the discriminant function was decreased, the percentage of persons correctly classified also decreased. When the number of variables was increased beyond 15, the discriminatory power also appeared to increase; however, the percentage correctly classified may be inflated due to an excessive number of blood tests for the number of subjects.

Effects of alcohol use and other health practices on blood chemistries and blood pressure.

Assessment of alcohol consumption, physical activity, nicotine use, diet patterns, blood pressure, height, and weight was done for 179 males. Subjects from four different populations were sampled to assure that the entire range of alcohol consumption from abstainers to alcoholics was represented. A blood chemistry profile of 33 tests, which included hematological parameters, lipids, electrolytes and minerals, renal function tests, and indicators of liver function was done for each subject. Tests of liver function and mean corpuscular volume were most strongly related to alcohol consumption. In contrast, there were other blood tests which were significantly related to nicotine use, age, body fatness or physical activity, but not to alcohol intake. Blood pressure, red blood cell count, and triglycerides were significantly related to several factors including alcohol consumption. The effect of alcohol on the blood chemistry profile was distinguished from the effects of nicotine, diet, body fatness, age and physical activity.

Interrelationships of moderate and high alcohol consumption with diet and health status.

Relationships of habitual alcohol consumption with diet and nutritional status were studied in 179 middle-class males with a wide range of alcohol consumption. One-day food records, diet histories, blood samples and data on alcohol consumption and meal patterns were collected. When data were analyzed by linear regression, there was a trend toward increased energy intake as alcohol consumption increased; however when the population was divided into tertiles based on alcohol consumption, the energy intakes were not significantly different between the tertile groupings. As alcohol intake increased, there was a decrease in percent of energy derived from protein, fat, and carbohydrate and the nutritional quality of the diet declined. Changes in health status, as measured by blood chemistries, were associated with both moderate and high alcohol consumption, although only three abnormal mean values were found in the upper tertile group.