Examining trust factors in online food risk information: The case of unpasteurized or 'raw' milk.

The internet has become an increasingly important way of communicating with consumers about food risk information. However, relatively little is known about how consumers evaluate and come to trust the information they encounter online. Using the example of unpasteurized or raw milk this paper presents two studies exploring the trust factors associated with online information about the risks and benefits of raw milk consumption. In the first study, eye-tracking data was collected from 33 pasteurised milk consumers whilst they viewed six different milk related websites. A descriptive analysis of the eye-tracking data was conducted to explore viewing patterns. Reports revealed the importance of images as a way of capturing initial attention and foregrounding other features and highlighted the significance of introductory text within a homepage. In the second, qualitative study, 41 consumers, some of whom drank raw milk, viewed a selection of milk related websites before participating in either a group discussion or interview. Seventeen of the participants also took part in a follow up telephone interview 2 weeks later. The qualitative data supports the importance of good design whilst noting that balance, authorship agenda, the nature of evidence and personal relevance were also key factors affecting consumers trust judgements. The results of both studies provide support for a staged approach to online trust in which consumers engage in a more rapid, heuristic assessment of a site before moving on to a more in-depth evaluation of the information available. Findings are discussed in relation to the development of trustworthy online food safety resources.

Health professionals' knowledge and understanding about Listeria monocytogenes indicates a need for improved professional training.

Listeria monocytogenes causes listeriosis, an uncommon but potentially fatal disease in immunocompromised persons, with a public health burden of approximately $2 billion annually. Those consumers most at risk are the highly susceptible populations otherwise known as the immunocompromised. Health professionals have a considerable amount of interaction with the immunocompromised and are therefore a valuable resource for providing appropriate safe food handling information. To determine how knowledgeable health professionals are about Listeria monocytogenes, a nationwide Web-based survey was distributed targeting registered nurses (RNs) and registered dietitians (RDs) who work with highly susceptible populations. Responses were received from 499 health professionals. Knowledge and understanding of Listeria monocytogenes was assessed descriptively. Parametric and nonparametric analyses were used to detect differences between RNs and RDs. The major finding is that there are gaps in knowledge and a self-declared lack of understanding by both groups, but especially RNs, about Listeria monocytogenes. RDs were more likely than RNs to provide information about specific foods and food storage behaviors to prevent a Listeria infection. Notably, neither group of health professionals consistently provided Listeria prevention messages to their immunocompromised patients. Pathogens will continue to emerge as food production, climate, water, and waste management systems change. Health professionals, represented by RNs and RDs, need resources and training to ensure that they are providing the most progressive information about various harmful pathogens; in this instance, Listeria monocytogenes.

Registered dietitian's personal beliefs and characteristics predict their teaching or intention to teach fresh vegetable food safety.

The Theory of Planned Behavior was used to determine if dietitians personal characteristics and beliefs about fresh vegetable food safety predict whether they currently teach, intend to teach, or neither currently teach nor intend to teach food safety information to their clients. Dietitians who participated in direct client education responded to this web-based survey (n=327). The survey evaluated three independent belief variables: Subjective Norm, Attitudes, and Perceived Behavioral Control. Spearman rho correlations were completed to determine variables that correlated best with current teaching behavior. Multinomial logistical regression was conducted to determine if the belief variables significantly predicted dietitians teaching behavior. Binary logistic regression was used to determine which independent variable was the better predictor of whether dietitians currently taught. Controlling for age, income, education, and gender, the multinomial logistical regression was significant. Perceived behavioral control was the best predictor of whether a dietitian currently taught fresh vegetable food safety. Factors affecting whether dietitians currently taught were confidence in fresh vegetable food safety knowledge, being socially influenced, and a positive attitude toward the teaching behavior. These results validate the importance of teaching food safety effectively and may be used to create more informed food safety curriculum for dietitians.

Qualitative studies of the food safety knowledge and perceptions of transplant patients.

Organ and stem cell transplant patients are at risk for foodborne illness due to disease and medically induced immunosuppression. The food safety knowledge and informational needs of these groups have not been documented in the literature. The objectives of this study were to assess transplant patients' food safety knowledge and perceptions, to probe the likelihood of practicing safe food handling behavior, and to test an educational strategy for future food safety interventions aimed at transplant patients. Subjects were organ or stem cell transplant patients, or their family care providers. Research was conducted in inpatient or outpatient facilities at a large, Midwestern United States comprehensive cancer and transplant center. Differences in survey data between the organ and stem cell transplant groups were determined by Student's t tests. Ethnographic methods were used to analyze qualitative focus groups and interview data for themes. Organ transplant patients had less motivation to follow food safety recommendations than did stem cell transplant patients, and they were more likely to consume risky foods. Stem cell transplant patients overall had a better understanding of their susceptibility to foodborne illness and had better prepared themselves with the knowledge and behavior changes needed to protect their health. Educational materials aimed at communicating food safety information for transplant patients were evaluated by patients and judged acceptable. This study found that organ transplant and stem cell transplant patients are distinct patient populations, with differing perceptions regarding the seriousness of foodborne illness and willingness to adopt preventative food handling practices. Population differences should be accounted for in food safety educational strategies.

Differences in Listeria monocytogenes contamination of rural Ohio residences with and without livestock.

To determine the contribution of on-site livestock to the environmental contamination of rural households with Listeria monocytogenes, a total of 1779 environmental and food samples were collected from 26 ruminant-farm households and 26 rural households in Ohio. L. monocytogenes isolates were identified and differentiated using sequence comparisons of the intragenic regions of inlB and inlC. L. monocytogenes was isolated from shoes, 9.6% (20/208); utility gloves, 5.4% (6/111); kitchen sinks, 1.5% (3/204); washing machines, 0.96% (2/204); food, 1.11% (7/631); and animal feces, 8.7% (9/104), over the course of four household visits at monthly intervals. Notably, L. monocytogenes-contaminated shoes were identified more frequently from ruminant farmhouses than from rural households that did not raise ruminants on site (odds ratio = 4.8). L. monocytogenes isolated from animal feces was indistinguishable from strains recovered from shoes and gloves stored in several homes. Our results highlight the potential of the rural household environment as source of L. monocytogenes exposure.

Zoonoses and the physicians' role in educating farming patients.

The purpose of this study was to characterize physicians' knowledge of zoonoses and perceived role in the process of zoonoses education among their farming patients in Northeast Ohio. In 2006, 92 practicing physicians (specialties included family medicine, internal medicine, obstetrics/gynecology, and preventive medicine) identified through Web-based hospital directories participated in a self-administered anonymous questionnaire. Descriptive analysis was used to summarize physicians' practice procedures, and self- perceived knowledge of zoonoses. The survey demonstrated that over 50% of physicians were either mostly uncomfortable or strongly uncomfortable with their knowledge of zoonoses, and in their ability to diagnose and make recommendations on how to prevent zoonotic infections. Fifty-four percent either strongly agreed or mostly agreed that it was important to ask patients who engage in livestock production about zoonoses exposure, but when asked to pick one professional category as the most responsible for educating individuals about agricultural-related zoonoses, the most frequent category chosen was public health official, followed by veterinarian, agricultural extension agent, and physician. Fifty-three percent felt a collaborative relationship with a veterinarian who possessed specialty training in zoonoses would be valuable to their practice. A gap may exist in the delivery of zoonoses information and patient care, requiring better communication between health care providers, veterinarians, and public health officials serving farmers.

Efficacy of sanitizing agents against Listeria monocytogenes biofilms on high-density polyethylene cutting board surfaces.

This study compared the effectiveness of 10 commercially available sanitizers against Listeria monocytogenes biofilms on high-density polyethylene cutting boards. Smooth and rough surface high-density polyethylene coupons (2 by 5 cm) were inoculated (approximately 6 log CFU/cm2) with a five-strain composite of L. monocytogenes in ham homogenate and incubated at 24 degrees C and > or = 90% relative humidity for up to 21 days. The coupons were subjected to repeated 24-h cycles simulating use and cleaning in the home. Each day, 0.3 ml of a 10-fold-diluted tryptic soy broth containing 0.6% yeast extract was added to each coupon (simulating exposure to nutrients during food preparation), and 8 h later each coupon was rinsed with sterile distilled water. Coupons were subjected to sanitizer treatments on days 0, 0.25, 7, 14, and 21. Eight quaternary ammonium compound (QAC)-based sanitizers, one of lactic acid-based sanitizer, and one sodium hypochlorite-based sanitizer were applied to individual coupons according to the manufacturers' instructions. Coupons were analyzed for L. monocytogenes (PALCAM agar) and total bacteria (tryptic soy agar with 0.6% yeast extract). At 0 and 0.25 days, nine of the sanitizers (all except for QAC-based sanitizer 10) had reduced L. monocytogenes to < 0.60 log CFU/cm2. For > or = 7-day-old biofilms, the lactic acid-based sanitizer (pH 3.03) was the most effective, and the QAC-based sanitizers were more effective when at pH 10.42 to 11.46 than at pH 6.24 to 8.70. Sanitizer efficacies were greater (P < 0.05) against younger (7 days) than older (21 days) biofilms on smooth surfaces. For 7- and 14-day-old biofilms, sanitizer efficacies were higher (P < 0.05) on smooth than on rough surfaces.

Discovery and development of educational strategies to encourage safe food handling behaviors in cancer patients.

Foodborne infections pose a threat to cancer patients who are immunocompromised because of disease or medical therapy. Comprehensive food safety education can raise cancer patients' awareness of risk for foodborne infections and encourage risk-reducing behavior. The objectives of this study were to assess food safety informational needs of cancer patients and to determine factors that may influence prospective educational interventions that foster risk-reducing behaviors. Focus groups with cancer patients were formed, and interviews with health professionals working with cancer patients were conducted. Findings were used to develop three educational resource prototypes for cancer patients. Information from two additional focus groups and interviews with cancer patients was used to evaluate the prototypes before revision and finalization. There was a general awareness among focus group participants that chemotherapy increased their susceptibility to foodborne illness and infections. Participants had a basic knowledge of safe food handling practices but did not necessarily link their awareness of increased susceptibility for infection with their routine food handling practices. When informed of specific high-risk foods, there was skepticism about compliance due to disbelief of the risk, personal preferences for the high-risk food, and lack of information about how to use the recommendation. Most of the health care providers agreed that food safety information should be provided by dietitians, physicians, and nurses, but physicians stated they had little time to do so. Cancer patients expressed positive attitudes toward the educational resource prototypes and willingness to follow the food safety recommendations provided.

Online continuing education course enhances nutrition and health professionals' knowledge of food safety issues of high-risk populations.

OBJECTIVE: To develop and evaluate the efficacy of an online continuing education course for professionals who provide food safety information to high-risk populations. DESIGN: A 2-credit graduate-level class was converted into six web-based modules (overview of foodborne illness, immunology, pregnancy, human immunodeficiency virus, cancer and transplants, and lifecycle) and offered to nutrition and health professionals. Participants had 8 weeks to complete the modules, pre and post questionnaires, and course evaluation. Those who successfully completed the protocol received six continuing education units from one of three professional associations. Change in knowledge was measured using pre and post questionnaires. Course efficacy was evaluated using a post-course questionnaire. SUBJECTS/SETTING: A convenience sample of 140 registered dietitians/dietetic technicians registered, nurses, and extension educators were recruited through professional conferences and electronic mailing lists to take the course. STATISTICAL ANALYSES: Analysis of variance was used to evaluate differences in knowledge scores for all groups across five main effects (attempt, module, profession, age, and education). Course evaluation responses were used to assess course effectiveness. RESULTS: For each module, knowledge scores increased significantly (P<0.001) from pre to post questionnaire. Overall, knowledge scores increased from 67.3% before the modules to 91.9% afterwards. Course evaluation responses were favorable, and participants indicated that course objectives were met. CONCLUSIONS: Online continuing education courses, such as "Food Safety Issues for High Risk Populations," seem to be a convenient, effective option for dietetics professionals, nurses, and extension educators seeking knowledge about food safety issues of high-risk populations. Online learning is a promising delivery approach for the continuing education of health professionals.

Food safety guidance for older adults.

Aging is associated with loss of the physical barriers and immune efficiency that typically control pathogens' access to and multiplication within the body, thus making infection more likely in elderly persons. Chronic diseases and other health factors, such as malnutrition and immobility, may increase susceptibility to and severity of infections, including foodborne illnesses, in elderly persons, as well as associated morbidity and mortality. Prevention is the best way to avoid foodborne illnesses, but older adults have long-established food preparation and handling practices, some of which may increase the likelihood of illness. Elderly persons rely on physicians as trusted sources of health information. Physicians and other health care professionals can help prevent and control foodborne diseases by educating their patients about the risks of foodborne illness, providing sound advice on safe food-handling and consumption practices, making rapid appropriate diagnoses, and reporting cases promptly to public health authorities.

Application of a five-step message development model for food safety education materials targeting people with HIV/AIDS.

Individuals with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome have an increased risk of contracting foodborne illnesses and need to take special precautions regarding food safety. We implemented a five-step model to assess the needs of people with HIV, develop education materials targeted to their needs, and evaluate acceptance of the materials. Needs assessment focus groups (n=8) with HIV-infected people (n=65) and interviews with health care providers (n=18) were conducted to determine motivators and barriers to adopting food safety recommendations. Education materials were developed using needs assessment data, literature on foodborne illnesses, and the Health Belief Model. Acceptability of materials was evaluated by focus groups (n=4) with HIV-infected people (n=32) and a survey of health care providers (n=25). Needs assessment focus group participants expressed resistance to and confusion about many recommendations. Prototype materials were designed to address barriers and motivators. HIV-infected people who reviewed the prototype materials in evaluation focus groups expressed positive attitudes about the materials, and most indicated willingness to follow recommendations. Health care providers were interested in distributing the education materials to their clients. Carefully listening to HIV-infected people and their health care providers, as well as detailed investigation of the literature on foodborne illnesses, contributed to acceptance of the education materials.

A logic model framework for community nutrition education.

Logic models are a practical method for systematically collecting impact data for community nutrition efforts, such as the Food Stamp Nutrition Education program. This report describes the process used to develop and test the Community Nutrition Education Logic Model and the results of a pilot study to determine whether national evaluation data could be captured without losing flexibility of programming and evaluation at the state level. The objectives were to develop an evaluation framework based on the Logic Model to include dietary quality, food safety, food security, and shopping behavior/food resource management and to develop a training mechanism for use. The portability feature of the model should allow application to a variety of community education programs.

Observation versus self-report: validation of a consumer food behavior questionnaire.

A reliable and validated set of food safety behavior questions that could be used with confidence when evaluating food safety education programs was identified in this study. A list of 29 food-handling and consumption behaviors rank-ordered within five pathogen control factors by nationally recognized food safety experts was the basis for the development of the behavior questions. Questions were evaluated for reliability and several forms of validity. During a kitchen activity session, 70 graduates of a nutrition education program completed four food preparation tasks while being observed and videotaped. The individuals also participated in an in-depth interview to validate behaviors that could not be observed during the food preparation activity, e.g., refraining from preparing food for others when experiencing diarrhea. Criterion validity was established by comparing questionnaire responses to observed behavior and interview responses. Twenty-eight questions met the validity criterion (> or = 70% agreement between observed and interviewed responses and self-reported responses), with three or more questions from each of five pathogen control factor areas. Observation assessments revealed that hand washing was more likely to be performed prior to beginning food preparation than between working with raw meats and fresh produce. Errors in methods of washing hands, utensils, and preparation surfaces between food preparation tasks were common. Most participants did not use thermometers to evaluate doneness but still cooked to safe internal temperatures. The results provide a tool that educators can use to evaluate food safety programs and will help guide the development of more effective food safety education programs targeting needed improvements in behavioral skills.

Awareness and acceptance of current food safety recommendations during pregnancy.

OBJECTIVES: To better understand pregnant women's food safety attitudes and beliefs that affect food selection, preparation and handling behaviors, sources of food safety information, motivators and barriers to adopting current recommendations, and preferences for receiving food safety materials. METHODS: Eleven focus groups were conducted with 69 women (57 pregnant and 12 less than 6 months postpartum). The Health Belief Model guided development of the moderator's guide. In the presence of each focus group, participants completed a food safety attitude/behavior questionnaire. Sessions were audiotaped, transcribed, and analyzed for common themes across and within groups. RESULTS: Most participants indicated moderate concern about food safety and had made some food handling or consumption changes since becoming pregnant; however, many were not following 7 of the 12 specific recommendations discussed. Further, there was resistance to change habits, especially for less well-known recommendations. The women assumed their food is safe, and wanted strong evidence regarding why they should change current practices. Common barriers included lack of prior awareness of most recommendations, no prior illness from implicated foods and the convenience, perceived health benefits of, and personal preference for many risky foods discussed. Participants wanted food safety information that was quick and easy to read, sufficiently thorough, and specifically targeted to pregnant women. CONCLUSIONS: The women studied had not internalized the connection between risky food consumption during pregnancy and risk to the unborn child, but expressed interest in valid information that might cause them to change their behaviors. The information gained will be useful in developing food safety educational materials for pregnant women.

Design and development of food safety knowledge and attitude scales for consumer food safety education.

OBJECTIVE: The objective of this study was to design and develop food safety knowledge and attitude scales based on food-handling guidelines developed by a national panel of food safety experts. DESIGN: Knowledge (n=43) and attitude (n=49) questions were developed and pilot-tested with a variety of consumer groups. Final questions were selected based on item analysis and on validity and reliability statistical tests. SUBJECTS/SETTING: Knowledge questions were tested in Washington State with participants in low-income nutrition education programs (pretest/posttest n=58, test/retest n=19) and college students (pretest/posttest n=34). Attitude questions were tested in Ohio with nutrition education program participants (n=30) and college students (non-nutrition majors n=138, nutrition majors n=57). STATISTICAL ANALYSES PERFORMED: Item analysis, paired sample t tests, Pearson's correlation coefficients, and Cronbach's alpha were used. RESULTS: Reliability and validity tests of individual items and the question sets were used to reduce the scales to 18 knowledge questions and 10 attitude questions. The knowledge and attitude scales covered topics ranked as important by a national panel of experts and met most validity and reliability standards. The 18-item knowledge questionnaire had instructional sensitivity (mean score increase of more than three points after instruction), internal reliability (Cronbach's alpha >.75), and produced similar results in test-retest without intervention (coefficient of stability=.81). Knowledge of correct procedures for hand washing and avoiding cross-contamination was widespread before instruction. Knowledge was limited regarding avoiding food preparation while ill, cooking hamburgers, high-risk foods, and whether cooked rice and potatoes could be stored at room temperature. The 10-item attitude scale had an appropriate range of responses (item difficulty) and produced similar results in test-retest ( P

Health care providers' attitudes toward current food safety recommendations for pregnant women.

Semistructured interviews were conducted with 23 health care professionals who work with pregnant women in a preliminary study to understand health care providers' attitudes regarding current food safety recommendations for pregnant women and interest in education and patient materials on food safety during pregnancy. Only 8 of 23 interviewed currently provided food safety information to their pregnant clients. Limited understanding of food safety issues and limited time with patients were barriers to providing such information. Based on their contact time with patients, background, and interest in food safety issues, nurses, visiting nurses, and Special Supplemental Nutrition Program for Women, Infants and Children professionals should be targeted as conveyers of food safety information to pregnant women.

Effect of male sex and obesity on platelet arachidonic acid in spontaneous hypertensive heart failure rats.

Sexual dimorphism is observed in the progression to congestive heart failure and, ultimately, in longevity in spontaneously hypertensive heart failure (SHHF) rats. As platelet activation may impact development of cardiovascular diseases, we studied the effects of obesity and sex on platelet polyunsaturated fatty acid (PUFA) profile and its relationship to platelet aggregation in 6-month-old SHHF rats. After a 24-hr fast, blood was obtained for measurement of platelet phospholipid omega-6 (n-6) and omega-3 (n-3) PUFA. Collagen-induced platelet aggregation was measured by whole-blood impedance aggregometry. Obese male (OM) SHHF had significantly more platelet arachidonic acid (AA) and total n-6 PUFA than lean males (LMs), lean females (LFs), or obese females (OFs). Platelet aggregation was enhanced in males compared to females, with OMs by 45% compared to OFs and with LMs by 28% compared to LFs. Though no difference was found between OFs and LFs, platelet aggregation was increased in OMs by 20% compared to LMs. Though not significantly different, lag time to initiate platelet aggregation tended to be shortest in OMs and then, in increasing duration, LMs, LFs, and OFs, suggesting that platelets from male rats were quicker to aggregate than those from females. Platelet aggregation was correlated with platelet AA and total n-6 PUFA content. There was no relationship between n-3 PUFA and platelet aggregation. In SHHF rats, elevated AA and n-6 PUFA levels in platelets are associated with enhanced platelet aggregation. This relationship is potentiated by obesity and male sex.

Food safety issues for cancer and organ transplant patients.

This paper explores reasons why cancer and transplant patients are at greater risk for food-borne illnesses and which pathogens and food-handling behaviors are of particular concern. Cancer and bone marrow transplant patients experience neutropenia because of medical treatments, whereas patients with solid organ transplants become immunosuppressed from a pharmacological regimen to prevent rejection of the transplanted organ. Opportunistic infections, including food-borne illnesses, may occur during periods of immunosuppression. Food-handling behaviors and practices to control food-borne illnesses were presented to focus groups and during interviews with cancer and transplant patients and health care providers. Credibility of the food safety information, credibility of the person providing the advice, and sensitivity to the restrictions imposed on the patient's lifestyle by food safety guidance were key themes from the focus group and interview study. The information gathered will help health care providers aid the cancer or transplant patient with their knowledge and understanding of food safety and their greater risk for food-borne infections.

Food handling behaviors of special importance for pregnant women, infants and young children, the elderly, and immune-compromised people.

This study used a Web-based Delphi process with a group of nationally recognized food safety experts to identify food-handling behaviors of special importance in reducing the risk of foodborne illness among pregnant women, infants and young children, elderly people, and people with compromised immune systems because of disease or pharmacologic therapy. Behaviors were related to 13 pathogens. Top-rated behaviors for pregnant women were associated with Listeria monocytogenes, Toxoplasma gondii, and Salmonella species. Top-rated behaviors for infants and young children, elderly people, and immune-compromised people were associated with a number of different pathogens. The results should help dietetics professionals and community health educators focus their efforts on those behaviors of special importance to the population being targeted.