Multistate surveillance for food-handling, preparation, and consumption behaviors associated with foodborne diseases: 1995 and 1996 BRFSS food-safety questions.

PROBLEM/CONDITION: In 1995, CDC, the Food and Drug Administration (FDA), and several state health departments collaboratively developed questions regarding food safety. This set of questions was used to collect data about food-handling, preparation, and consumption behaviors that have been associated with foodborne diseases in adults. These data will help characterize persons at high risk for foodborne illness and assist in developing food-safety education strategies for consumers and foodhandlers that are intended to reduce foodborne illness. REPORTING PERIOD COVERED: January 1995-December 1996. DESCRIPTION OF SYSTEM: Data were collected by using the 12 food-safety questions, which were administered with the 1995 Behavioral Risk Factor Surveillance Systems (BRFSS) in Colorado, Florida, Missouri, New York, and Tennessee, and the 1996 BRFSS in Indiana and New Jersey. In addition, data were collected in South Dakota from two of the standardized questions that deal with consumption of undercooked eggs and pink hamburgers. The BRFSS is a state-based system that surveys noninstitutionalized adults by telephone about their health behaviors and practices. RESULTS: This study included 19,356 completed questionnaires (2,461 in Colorado; 3,335 in Florida; 2,212 in Indiana; 1,572 in Missouri; 3,149 in New Jersey; 2,477 in New York; 2,110 in South Dakota; and 2,040 in Tennessee). During the previous 12 months, 50.2% of respondents reported eating undercooked eggs (95% confidence interval [CI] = 49.2-51.2); 23.8% reported eating home-canned vegetables (95% CI = 22.5-24.5); 19.7% reported eating pink hamburgers (95% CI = 18.9-20.5); 8.0% reported eating raw oysters (95% CI = 7.5-8.5); and 1.4% reported drinking raw milk (95% CI = 1.2-1.6). The prevalence of not washing hands with soap after handling raw meat or chicken and not washing a cutting board with soap or bleach after using it for cutting raw meat or chicken were 18.6% (95% CI = 17.8-19.4) and 19.5% (95% CI = 18.6-20.4), respectively. Less than half of respondents (45.4%, 95% CI = 44.2-46.6) reported seeing safe food-handling label information on raw meat products. In addition, among those persons who reported they remembered seeing the label information, 77.2% (95% CI = 76.0-78.4) remembered reading the label information, and 36.7% reported changing their meat and poultry preparation habits because of the labels (95% CI = 35.2-38.2). When population characteristics were considered in the analysis, all high-risk food-handling, preparation, and consumption behaviors were more prevalent in men than in women. Eating pink hamburgers during the previous 12 months was more commonly reported by whites (22.3%) than by blacks (6.5%). The prevalence of reported consumption of pink hamburgers during the previous. 12 months decreased with age (18-29 years: 21.8%, 30-59 years: 21.9%, and 60-99 years: 13.2%); increased with education (less than grade 12: 12.0%, high school graduate: 16.5%, and any college education: 24.0%); and increased with income (< $15,000: 11.8%, $15,000-$34,999: 17.6%, $35,000-$49,999: 22.0%, and > or = $50,000: 28.6%). INTERPRETATION: During 1995-1996, several high-risk food-handling, preparation, and consumption behaviors were common, and some were particular to specific population groups. Based on this analysis, interventions are needed to reduce the prevalence of these risky behaviors. All consumers and foodhandlers could benefit from food-safety education. ACTIONS TAKEN: Behavioral surveillance systems can provide data that identify persons or groups in which behaviors associated with foodborne diseases are more common and who are at higher risk for foodborne illness. State-specific data can assist in developing food-safety education programs and, if collected periodically, can be used to evaluate program effectiveness.

Women at risk: papanicolaou smear screening in Florida.

In the South, especially Appalachia, the incidence of invasive cervical cancer has remained high relative to the rest of the United States. Populous Florida now stands third among states by incidence and fifth from last in Pap screening. During the 1994 survey, 2,059 Florida women chosen as a multi-stage cluster sample were interviewed concerning their use of screening Pap smears. Never-participation in screening percentages were significantly higher in Hispanic women (14.7%), those sharing household incomes of less than $10,000 (13.2%), and women limited to a high school education (10.7%), but not among respondents older than 64 years of age (8.7%). Despite continued annual physician contact by most, yearly Pap smears fell to only 57.0% among women aged 55-64 years. It is important that physicians target these women and use any appropriate clinical contact to educate them about risk factors for cervical cancer while encouraging regular, continued use of this life-saving test.

Survey of clinical breast examinations and use of screening mammography in Florida.

This study examined data on usage of screening mammograms and clinical breast examination (CBE) by 1,339 Florida women interviewed during the 1991 Behavioral Risk Factor Surveillance Survey. Among women 20 to 40 years old, 87.3% reported a CBE within the past 3 years, exceeding the guidelines of the American Cancer Society. Among older women, 70.4% had a CBE within the past year as recommended. However, only a bare majority (50.5%) of those aged 50 or older had obtained a mammogram in the past year. Annual household income, but not educational level, was positively associated with adherence to mammography. Among those having mammograms, self-referred women were more educated, more affluent, and more likely to be white than were physician-referred women. Further efforts and resources must be directed toward education of physicians and the public on the value of regular mammography for all Florida women, especially for our elderly and economically disadvantaged.

BRFSS-based survey of the Florida public on restaurant smoking.

A total of 2,246 Floridians were randomly surveyed by telephone concerning the Florida Clean Indoor Air Act and smoking in restaurants. Only 28.8% responded correctly that restaurant smoking is prohibited unless a manager's sign specifically permits it. More than 80% of smokers felt free to light up in the absence of such signs and over 45% of nonsmokers did not recognize this as an infringement of their rights. Although about three-quarters of Floridians are nonsmokers, only about half the state's restaurant seating capacity was intended for nonsmokers by managers. Based on their own experience, smoking Floridians were much more likely (67.1%) to be satisfied with their allocation of seating than were nonsmokers (45.9%). Uniquely among states, Florida's law preempts all local ordinances, past and future. The Clean Indoor Air Act is of little practical value because it is understood by so few. It allows no restrictions on smoking in 42% of Florida's restaurants, those with fewer than 51 seats.