A multi-state survey of consumer food-handling and food-consumption practices.

INTRODUCTION: In the United States, foodborne infections cause an estimated 6.5-33 million illnesses a year. Also included in the burden of foodborne illnesses are sequelae such as hemolytic uremic syndrome, Guillain-Barré syndrome, and reactive arthritis. Surveillance for risky food-handling and food-consumption practices can be used to identify high-risk populations, develop educational efforts, and evaluate progress toward risk reduction. DESIGN: In 1995 and 1996, Behavioral Risk Factor Surveillance System interviews of 19,356 adults in eight states (1995: Colorado, Florida, Missouri, New York, and Tennessee; 1996: Indiana, New Jersey, and South Dakota) included questions related to food-handling and/or food-consumption practices. Risky food-handling and food-consumption practices were not uncommon. Overall, 19% of respondents did not adequately wash hands or cutting boards after contact with raw meat or chicken. During the previous year, 20% ate pink hamburgers, 50% ate undercooked eggs, 8% ate raw oysters, and 1% drank raw milk. Men were more likely to report risky practices than women. The prevalence of most risky behaviors increased with increasing socioeconomic status. CONCLUSION: Targeted education efforts may reduce the frequency of these behaviors. Periodic surveillance can be used to assess effectiveness. In addition to consumer education, prevention efforts are needed throughout the food chain including on the farm, in processing, distribution, and at retail.

Cheese-associated outbreaks of human illness in the United States, 1973 to 1992: sanitary manufacturing practices protect consumers.

To identify contributing factors for cheese-associated outbreaks, we reviewed all cheese-associated outbreaks of human illness reported to the Centers for Disease Control and Prevention (CDC) with onsets during 1973 to 1992. The infrequency of large, cheese-associated outbreaks was notable because such outbreaks had been a frequent public health problem before the mid-20th century. Of 32 reported cheese-associated outbreaks, 11 attributed to manufacturing errors caused most of the illnesses and hospitalizations and all 58 deaths. Important factors in these 11 outbreaks were manufacturing cheese with raw or improperly pasteurized milk and postpasteurization contamination. If current Food and Drug Administration sanitary requirements for cheesemaking had been met, these outbreaks would have been preventable. In two outbreaks of Salmonella infections, fewer than 10 Salmonella per 100 g of cheese were detected. In two outbreaks of Brucella infections, efforts to recover the pathogen from the implicated cheese were unsuccessful, emphasizing the inadequacy of end product testing for assuring consumer safety. Curing cheeses kills most bacteria present in cheeses; however, evidence from sources other than the CDC Foodborne Disease Outbreak Surveillance System suggests that curing alone may not be a sufficient pathogen control step to eliminate Salmonella, Listeria, and E. coli O157:H7 from cheese.

Raw shellfish consumption and warning labels: results from the 1993 Texas Behavioral Risk Factor Surveillance System (BRFSS) survey.

We used the 1993 Texas Behavioral Risk Factor Surveillance System survey to assess the prevalence of raw shellfish consumption and to find the demographic and behavioral characteristics of raw shellfish consumers. We studied the general impact of warning labels reported by survey respondents. Data were analyzed using univariate and multiple logistic regression methods. Fourteen percent of the Texas surveyed reported consuming raw shellfish. Respondents with incomes greater than or equal to $25,000 and with education beyond high school were more likely to report consuming raw shellfish than were those with incomes less than $25,000 and with high school diplomas or less. Respondents at risk for acute and chronic drinking, driving while intoxicated, and driving without a seat belt were more likely than those not at risk of these behaviors to report consumption of raw shellfish. We did not find a significant difference between eaters and noneaters of raw shellfish regarding the impact of warning labels: however, among eaters of raw shellfish, older respondents were more likely than younger respondents to report that warning labels had no effect on them.

Raw shellfish consumption in California: the 1992 California Behavioral Risk Factor Survey.

We used the 1992 California Behavioral Risk Factor Surveillance System to study the prevalence of raw shellfish consumption in California and the demographic and behavioral characteristics of raw shellfish consumers. We used the logistic regression analysis of the weighted survey data with PC SAS and SUDAAN to adjust for the effects of age and gender. Twenty-three percent of the respondents in the survey reported that they ate raw shellfish; one third of these reported eating raw shellfish once a month. Higher prevalences of raw shellfish consumption were reported by men, persons 18-49 years old, those with income above $25,000 and education beyond high school than by women, individuals older than 49 years, and those with an income of $25,000 or less per year and 12 or fewer years of school. A higher percentage of persons with liver disease, stomach surgery, and a history of chronic alcohol drinking reported consumption of raw shellfish than did individuals without liver disease, previous stomach surgery, or a history of alcohol abuse. After adjustment for gender and age, those who reported acute (P < .01) and chronic (P < .01) drinking and driving while intoxicated (P < .01) were more likely to report consumption of raw shellfish. Two variables (lack of seat belt usage [P = 2] and cigarette smoking [P = .13]) were not significantly associated statistically with raw shellfish consumption.

Associations between diet and health behavior: results from the 1992 Rhode Island Behavioral Risk Factor Survey.

The 1992 Rhode Island Behavioral Risk Factor Surveillance System was used to assess self-reported health behaviors of consumers of finfish and raw shellfish. We hypothesized that consumers of finfish, foods considered to be healthy, were more likely than nonconsumers of finfish to partake in health-promoting behaviors. Similarly, we postulated that consumers of raw molluscan shellfish, foods linked to an elevated risk of acquiring various illnesses, were more likely than nonconsumers of raw-shellfish to partake in risk-taking behaviors. Finfish eaters were significantly more likely than abstainers to report recent exercise, efforts to lose weight, periodic monitoring of serum cholesterol, and not currently being smokers. Raw shellfish eaters were significantly more likely than abstainers to report recent acute and chronic alcohol consumption. The results suggest that inquiry into dietary patterns may be an avenue for exploring other health behaviors.

Nutrition: a cofactor in HIV disease.

The relationships among nutritional status, infectious disease, and the immune system suggest that nutrition may be a cofactor in human immunodeficiency virus (HIV) progression. We examined nutrition as a cofactor in HIV disease by reviewing the current literature on the interactions of nutrition, infectious disease processes, and immune system dysfunction. Studies demonstrate that poor nutritional status and infection affect the immune system and interact with each other. This relationship leads to the development of opportunistic infections and malignancies, which may result in a diagnosis of acquired immunodeficiency syndrome. Moreover, evidence from our review indicates that nutritional status may play a role in HIV disease progression. We recommend that clinical trials be conducted to evaluate general malnutrition and the efficacy of supplementation with specific nutrients at various stages of HIV disease.

Tuberculosis and AIDS in South Carolina: a case-control study.

The epidemiologic features of tuberculosis patients with AIDS or HIV infection in this study do not appear to be different from those reported from previous studies. Tuberculosis patients with AIDS or HIV positive antibody in South Carolina are predominantly black males who live in the urban areas and are 25 to 44 years old. They have more extrapulmonary sites and more anergic reactions to tuberculin tests. Physicians and other public health workers should be aware of the abnormal clinical and laboratory manifestations of tuberculosis patients with AIDS and HIV infection. It is also imperative for tuberculosis control programs to offer counseling and HIV antibody testing to tuberculosis patients.