Characteristics of U.S. Consumers Reporting Past Year Intake of Raw (Unpasteurized) Milk: Results from the 2016 Food Safety Survey and 2019 Food Safety and Nutrition Survey.

ABSTRACT: Consumption of unpasteurized (raw) milk has been linked to foodborne illness in the United States at higher relative rates than has consumption of pasteurized milk and milk products. Regulation of these products differs by state. Regardless of the risk of consumption, some people still purchase and consume unpasteurized milk. Based on information from the 2016 Food Safety Survey and the 2019 Food Safety and Nutrition Survey conducted by the U.S. Food and Drug Administration, we evaluated prevalence, frequency, and demographic predictors of consumption of raw milk in the U.S. adult population. Results show that 4.4% of U.S. adults reported consuming raw milk at least once in the past year, with 1.6% reporting frequent consumption of raw milk (once per month or more often) and 1.0% reporting consumption once per week or more often. The individuals who consumed raw milk in the previous 12 months were more likely to be younger, living in a rural area, and living in a state in which retail sale of raw milk is legal. These results provide quantitative information on consumption prevalence and frequency and demographic characteristics of individuals who consume unpasteurized milk in the United States.

Health Disparities in Calorie Knowledge and Confidence Among the U.S. Adult Population.

PURPOSE: Obesity prevalence has reached an all-time high in the US, affecting >40% of the population. This study's objective was to evaluate associations between demographics and self-reported calorie knowledge and self-perceived confidence in calorie knowledge ("calorie confidence"). The relationships between body mass index (BMI) and calorie knowledge and confidence were also explored. METHODS: We analyzed data from participants (n = 2171) in the crosssectional, nationally representative 2019 FDA Food Safety and Nutrition Survey using logistic regression to estimate adjusted odds ratios (AORs) and confidence intervals (95% CIs) for associations between BMI and calorie knowledge (correct/incorrect), calorie confidence (confident/not confident), and demographic characteristics, and the Wald chi square test to evaluate relationships between BMI and both calorie knowledge and confidence. RESULTS: Many of the same subgroups were more likely than others to report lack of calorie knowledge and lack of confidence in knowing the typical daily calorie intake needed to maintain a healthy weight [respective AORs (95% CIs): age (years), >60 vs 51-60, 1.7 (1.1-2.5), and 1.4 (1.0-2.0); sex, male vs female, 1.7 (1.3-2.3), and 1.7 (1.3-2.1); race/ethnicity, non-Hispanic Black vs non-Hispanic white, 3.4 (2.1-5.5), and 2.4 (1.6-3.8); education, ≤high school vs college grad, 1.5 (1.0- 2.3), and 1.9 (1.3-2.7)]. BMI was significantly correlated with calorie confidence (P = .047), such that those reporting less confidence were more likely overweight or obese [underweight/healthy (BMI < 25): 29%, overweight (25 ≤ BMI < 30): 34%, obese (BMI ≥ 30): 37%]. CONCLUSION: In certain demographic subgroups associations between calorie knowledge and confidence differed. Tailored education and outreach for these groups may help to address these disparities.

Pet Ownership and Pet Type Influence Food Safety in the Home: Evidence from a National Survey.

ABSTRACT: Physical contact between humans and their pets increases the potential for zoonotic disease transmission. This study used the 2016 U.S. Food and Drug Administration (FDA) Food Safety Survey to compare the food handling behaviors of pet owners and non-pet owners, because poor food handling and hygiene habits can increase the likelihood of disease transmission from animals to humans. Results show that both pet ownership and pet type were important in predicting food safety behaviors. After controlling for sociodemographic factors included in this study (gender, age, household income, household size, and race or ethnicity), pet ownership was significantly associated with overall food safety practices and, more specifically, with better hand washing behaviors, kitchen cleaning, and ownership and use of a food thermometer, as well as a greater awareness of foodborne pathogens. Cat owners and cat-dog owners had better overall food safety practices and better hand washing behaviors compared with those of dog owners. After controlling for sociodemographic variables, there were no significant associations between pet ownership and perception of risks associated with unsafe food handling practices.

Consumers' Use of Personal Electronic Devices in the Kitchen.

Smartphones, tablets, and other personal electronic devices have become ubiquitous in Americans' daily lives. These devices are used by people throughout the day, including while preparing food. For example, a device may be used to look at recipes and therefore be touched multiple times during food preparation. Previous research has indicated that cell phones can harbor bacteria, including opportunistic human pathogens such as Staphylococcus and Klebsiella spp. This investigation was conducted with data from the 2016 Food Safety Survey (FSS) and from subsequent focus groups to determine the frequency with which consumers use personal electronic devices in the kitchen while preparing food, the types of devices used, and hand washing behaviors after handling these devices. The 2016 FSS is the seventh wave of a repeated cross-sectional survey conducted by the U.S. Food and Drug Administration in collaboration with the U.S. Department of Agriculture. The goal of the FSS is to evaluate U.S. adult consumer attitudes, behaviors, and knowledge about food safety. The FSS included 4,169 adults that were contacted using a dual-frame (land line and cell phone interviews) random-digit-dial sampling process. The personal electronics module was the first of three food safety topics discussed by each of eight consumer focus groups, which were convened in four U.S. cities in fall 2016. Results from the 2016 FSS revealed that of those individuals who use personal electronic devices while cooking, only about one third reported washing hands after touching the device and before continuing cooking. This proportion is significantly lower than that for self-reported hand washing behaviors after touching risky food products such as raw eggs, meat, chicken, or fish. Results from the focus groups highlight the varied usage of these devices during food preparation and the related strategies consumers are using to incorporate personal electric devices into their cooking routines.

Vitamin-Fortified Snack Food May Lead Consumers to Make Poor Dietary Decisions.

BACKGROUND: The US Food and Drug Administration's (FDA's) fortification policy discourages the fortification of certain foods, including sugars and snack foods such as cookies, candies, cakes, chips, and carbonated beverages, yet manufacturers sometimes add vitamins and minerals to snack foods. OBJECTIVE: To assess whether vitamin-fortified snack foods affect consumers' information-seeking, purchase decisions, and product-related health perceptions. DESIGN: For this experimental study, participants were randomly assigned to study conditions to compare products that varied in product type, nutrition profile, and fortification and nutrient claim status. Data were collected via an online consumer panel. PARTICIPANTS/SETTING: US adults aged 18 years and older were randomly selected from Research Now's e-panel online household panel. Data were collected during fall 2014 (N=5,076). INTERVENTION: Participants were randomly assigned to one of 24 conditions: two products (vegetable chip/potato chip), two nutrition profiles (healthier/less healthy), two fortification scenarios (not fortified/fortified), and three nutrient claim conditions (two no claim/one with claim). The design was not balanced; claims were not shown on products that were not vitamin fortified. MAIN OUTCOME MEASURES: Outcome measures were information-seeking (viewed the Nutrition Facts label), purchase decisions, perception of product healthfulness, and correct selection of product with the healthier nutrient profile. STATISTICAL ANALYSIS PERFORMED: Logistic regression was used to test all models. Analyses was adjusted for general label use, consumes product, health status, age, sex, level of education, presence of children in the household, and race/ethnicity. RESULTS: When the snack food carried a nutrient claim for vitamin fortification, participants were 1) less likely to look for nutrition information on the Nutrition Facts label, 2) more likely to select the product for purchase, 3) more likely to perceive the product as healthier, and 4) less likely to correctly choose the healthier product. CONCLUSIONS: Snack foods that have been vitamin-fortified may cause consumers to make poor dietary decisions.

Single-larger-portion-size and dual-column nutrition labeling may help consumers make more healthful food choices.

BACKGROUND: The Food and Drug Administration is considering changes to the Nutrition Facts label to help consumers make more healthful choices. OBJECTIVE: To examine the effects of modifications to the Nutrition Facts label on foods that can be listed as having 1 or 2 servings per container, but are reasonably consumed at a single eating occasion. DESIGN: Participants were randomly assigned to study conditions that varied on label format, product, and nutrition profile. Data were collected via an online consumer panel. PARTICIPANTS/SETTING: Adults aged 18 years and older were recruited from Synovate's online household panel. Data were collected during August 2011. A total of 32,897 invitations were sent for a final sample of 9,493 interviews. INTERVENTION: Participants were randomly assigned to one of 10 label formats classified into three groups: listing 2 servings per container with a single column, listing 2 servings per container with a dual column, and listing a single serving per container. Within these groups there were versions that enlarged the font size for "calories," removed "calories from fat," and changed the wording for serving size declaration. MAIN OUTCOME MEASURES: The single product task measured product healthfulness, the amount of calories and various nutrients per serving and per container, and label perceptions. The product comparison task measured ability to identify the healthier product and the product with fewer calories per container and per serving. STATISTICAL ANALYSES PERFORMED: Analysis of covariance models with Tukey-Kramer tests were used. Covariates included general label use, age, sex, level of education, and race/ethnicity. RESULTS: Single-serving and dual-column formats performed better and scored higher on most outcome measures. CONCLUSIONS: For products that contain 2 servings but are customarily consumed at a single eating occasion, using a single-serving or dual-column labeling approach may help consumers make healthier food choices.

Awareness of methylmercury in fish and fish consumption among pregnant and postpartum women and women of childbearing age in the United States.

In 2004, the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) reissued joint advice recommending that pregnant women, nursing mothers, young children, and women who may become pregnant not consume fish high in mercury such as shark, swordfish, king mackerel, and tilefish, and not consume more than 12 ounces (340.2g) of other lower mercury fish per week. These groups were encouraged to eat up to 12 ounces (340.2g) of low mercury fish per week to get the health benefits of fish. Using a survey of 1286 pregnant women, 522 postpartum women, and a control group of 1349 non-pregnant/non-postpartum women of childbearing age, this study evaluated awareness of mercury as a problem in food and examined fish consumption levels across groups using regression analysis. We also compared awareness of mercury as a problem in food to awareness of Listeria, dioxins and PCBs. We found that the majority of all 3 groups of women were aware of mercury and that nearly all women in all 3 groups limited consumption consistent with the advice; they ate less than 340.2g (12 oz) of fish per week and no high mercury fish. Compared with the control group, pregnant and postpartum women were more likely to be aware of mercury as a problem in food, and pregnant women ate less total fish and were less likely to eat fish, to eat more than 340.2g (12 oz) of fish, and to eat high mercury fish. However, all groups ate much less than the recommended 340.2g (12 oz) of low mercury fish per week for optimum health benefits. Among women who ate fish, the median intake of total fish was 51.6 g/wk (1.8 oz/wk), 71.4 g/wk (2.5 oz/wk), and 85.3 g/wk (3.0 oz/wk) for the pregnant, postpartum, and control groups, respectively. Thus, it appears that the targeted groups of women were more aware of mercury and were eating fish within the FDA/EPA guidelines, but these women may be missing the health benefits to themselves and their children of eating a sufficient amount of fish.

Trends in ownership and usage of food thermometers in the United States, 1998 through 2010.

Food safety research has shown that the use of a food thermometer is the best way to ensure that meat, poultry, and other foods reach an internal temperature sufficient to destroy foodborne pathogens. The 1998, 2001, 2006, and 2010 Food Safety Surveys were used to analyze changes in food thermometer ownership and usage for roasts, chicken parts, and hamburgers in the United States. A probit regression model was used to evaluate differing trends in ownership across demographic subgroups, and probit models with sample selection were used to evaluate differing trends in food thermometer usage for roasts, chicken parts, and hamburgers. The Food Safety Surveys are nationally representative telephone surveys tracking consumers' food safety attitudes and behaviors. Findings from these surveys indicate that the percentage of consumers who own food thermometers has increased from 49% in 1998 to 70% in 2010 (P < 0.05). The use of food thermometers has also increased over this time period but varies by food type. Of those who own food thermometers, a higher percentage reported using thermometers for roasts (76% in 1998 and 82% in 2010, P < 0.05) than for chicken parts (33% in 1998 and 53% in 2010, P < 0.05) and hamburgers (14% in 1998 and 23% in 2010, P < 0.05). The results also show that men, non-Hispanic whites, those with some college education or higher, those with higher incomes, and those 65 years and older were more likely to own food thermometers. After controlling for food thermometer ownership, those aged 18 to 29 years were more likely to use a food thermometer for roasts and chicken parts than those aged 65 to 101 years. The results suggest that educational programs encouraging food thermometer usage should focus first on food thermometer ownership.

Trends in U.S. consumers' safe handling and consumption of food and their risk perceptions, 1988 through 2010.

Although survey results measuring the safety of consumers' food handling and risky food consumption practices have been published for over 20 years, evaluation of trends is impossible because the designs of published studies are not comparable. The Food Safety Surveys used comparable methods to interview U.S. adults by telephone in 1988, 1993, 2001, 2006, and 2010 about food handling (i.e., cross-contamination prevention) and risky consumption practices (eating raw or undercooked foods from animals) and perceived risk from foodborne illness. Sample sizes ranged from 1,620 to 4,547. Responses were analyzed descriptively, and four indices measuring meat, chicken, and egg cross-contamination, fish cross-contamination, risky consumption, and risk perceptions were analyzed using generalized linear models. The extent of media coverage of food safety issues was also examined. We found a substantial improvement in food handling and consumption practices and an increase in perceived risk from foodborne illness between 1993 and 1998. All indices were stable or declined between 1998 and 2006. Between 2006 and 2010, the two safe food handling practice indices increased significantly, but risk perceptions did not change, and safe consumption declined. Women had safer food handling and consumption practices than men. The oldest and youngest respondents and those with the highest education had the least safe food handling behaviors. Changes in safety of practices over the survey years are consistent with the change in the number of media stories about food safety in the periods between surveys. This finding suggests that increased media attention to food safety issues may raise awareness of food safety hazards and increase vigilance in food handling by consumers.

Awareness and knowledge of methylmercury in fish in the United States.

In the 1970s several states in the Great Lakes region became concerned about mercury contamination in lakes and rivers and were the first to issue local fish consumption advisories. In 2001, the Food and Drug Administration (FDA) advised pregnant women, nursing mothers, young children, and women who may become pregnant not to consume shark, swordfish, king mackerel, and tilefish and recommended that these women not exceed 12 ounces of other fish per week. In 2004, FDA reissued this advice jointly with the U.S. Environmental Protection Agency (EPA) and modified it slightly to provide information about consumption of canned tuna and more details about consumption of recreationally caught fish. Though several studies have examined consumers' awareness of the joint FDA and EPA advisory as well as different state advisories, few used representative data. We examined the changes in awareness and knowledge of mercury as a problem in fish using the pooled nationally representative 2001 and 2006 Food Safety Surveys (FSS) with sample sizes of 4482 in 2001 and 2275 in 2006. Our results indicated an increase in consumers' awareness of mercury as a problem in fish (69% in 2001 to 80% in 2006, p<.001). In our regression models, we found that in both years, parents having children less than 5 years of age were more aware of mercury in fish and knowledgeable about the information contained in the national advisories about mercury in fish (p<.01) than other adults. In both 2001 and 2006, women of childbearing age (aged 18-45) were less aware and knowledgeable about this information than other women. However, women of all age groups had larger gains in awareness and knowledge than their male counterparts during this time. Participants' race, education, income, region, fish preparation experiences, having a foodborne illness in the past year, and risk perceptions about the safety of food were significant predictors of their awareness and knowledge.

Helping consumers make more healthful food choices: consumer views on modifying food labels and providing point-of-purchase nutrition information at quick-service restaurants.

OBJECTIVES: To understand consumer (1) interest in nutrition information on food labels and quick-service restaurant menu boards and (2) reactions to modifying this information to help highlight calories and more healthful choices. DESIGN: Eight consumer focus groups, using a guide and stimuli. SETTING: Focus group discussions in 4 US cities. PARTICIPANTS: A total of 68 consumers, with 7 to 10 per focus group. ANALYSIS: Authors prepared detailed summaries of discussions based on observation. Video recordings and transcripts were used to cross-check summaries. Data were systematically reviewed, synthesized, and analyzed. PHENOMENON OF INTEREST: Consumer views on alternative presentations of nutrition information on packaged food items and quick-service restaurant menu boards. RESULTS: Participants (1) were interested in having nutrition information available, but would not use it at every eating occasion; (2) thought that food products typically consumed at 1 eating occasion should be labeled as a single serving; and (3) indicated that an icon on labels and menu boards that signaled more healthful options could be helpful. CONCLUSIONS AND IMPLICATIONS: Findings provide a basis for the development of more systematic studies to better understand whether alternative presentations of nutrition information would help consumers.