Investigating awareness, fear and control associated with norovirus and other pathogens and pollutants using best-worst scaling.

Pollutants found in the water and air environment represent an ever-growing threat to human health. Contact with some air-, water- and foodborne pathogens (e.g. norovirus) results in gastrointestinal diseases and outbreaks. For future risk mitigation, we aimed to measure people's awareness of waterborne and foodborne norovirus relative to other environment-associated pollutants (e.g. pesticides, bioaerosols, antibiotic resistant bacteria) and well-known risks (e.g. diabetes, dementia, terrorist attack). We used an online survey, which included a best-worst scaling component to elicit personal levels of control and fear prompted by norovirus relative to 15 other risks. There was a negative correlation between levels of fear vs. control for all 16 measured risks. Perceived infection control levels were higher amongst women compared to men and correlated with age and the level of qualification in both groups. Participants who had sought advice regarding the symptoms caused by norovirus appeared to have more control over the risks. Norovirus is associated with high levels of fear, however, the levels of control over it is low compared to other foodborne illnesses, e.g. Salmonella. Addressing this deficit in the public's understanding of how to control exposure to the pathogen in an important health need.

Moving Forward to the Future: A Review of Microbial Food Safety Education in China.

Millions of foodborne illness cases occur in China annually, causing significant social and economic burdens. Improper food handling has been observed not only among commercial food handlers but also among residential food handlers. It is critical to conduct a comprehensive scoping review of previous efforts to identify food safety knowledge gaps, explore the factors impacting knowledge levels, and synthesize the effectiveness of all types of food safety educational interventions for commercial and residential food handlers in China. This review aims to analyze food safety education studies published over the past 20 years and provide foundations for developing more effective food safety educational interventions in China. A total of 35 studies were included in this review. Most studies reported that Chinese commercial and residential food handlers had insufficient food safety knowledge, especially in the areas of foodborne pathogens and safe food-handling practices. The factors impacting food handlers' knowledge levels included education level, gender, income level, residency (rural vs. urban), the use of WeMedia, college students' major, and food safety training experiences. Food handlers in the following demographic groups tend to have lower levels of food safety knowledge: lower education levels, the elderly, males, lower-income levels, rural residents, those who do not use WeMedia, those without food safety training experience, or college students in nonbiology-focused majors. Many food handlers did not always follow recommended food safety practices, such as proper meat handling practices, handwashing practices, and cleaning and sanitation practices. Thirteen studies evaluated the effectiveness of educational interventions, and knowledge increases were reported after all interventions. The findings of this review provide guidance to researchers, educators, and government agencies in their future efforts to develop education programs emphasizing the importance of microbial food-safety content and behavior change regarding food safety and hygiene practices.

Cognitive Biases of Consumers' Risk Perception of Foodborne Diseases in China: Examining Anchoring Effect.

Consumer cognitive biases arise from judgment and decision-making due to their limitations in information processing. As one of the important cognitive biases, the anchoring effect plays a significant role in interfering with consumers' risk perception. With a stratified random approach, we collected survey data from 375 consumers in Wuxi, Jiangsu Province, China. Based on these data, this study attempted to analyze the anchoring effect in consumers' risk perception of foodborne diseases (FBDs) and the differences in their perception before and after intervention in a contrast experiment using the anchoring index and the Wilcoxon signed-rank test. The results confirm the existence of the proposed anchoring effect. Moreover, the experimenter-provided anchor value, a history of FBD, and familiarity with FBD were found to be important factors influencing this anchoring effect. Therefore, improving consumers' risk perception of FBD is critical to the long-term prevention of FBD risks by the government and consumers. The government should strengthen active monitoring, publicity, and education about FBD.

Knowledge, attitude and practices among parents regarding food poisoning: a cross-sectional study from Palestine.

BACKGROUND: Food serves as a vehicle for many pathogenic and toxigenic agents that cause food-borne diseases. Knowledge, attitude, and practices are key factors in reducing the incidence of food-borne diseases in food service areas. The main objective of this study was to evaluate knowledge, attitude, and practices related to food poisoning among parents of children in Nablus, Palestine. METHODS: A cross-sectional study was conducted in primary healthcare centers in Nablus district from May to July 2015. Data were collected using structured questionnaire interviews with parents to collect information on food safety knowledge, attitudes, and practices, alongside sociodemographic characteristics. RESULTS: Four-hundred and twelve parents were interviewed, 92.7% were mothers. The median knowledge score was 12.0 with an interquartile range (IQR) of 11.0-14.0. The median attitude score was 11.0 with IQR of 10.0-13.0, while the median practice score was 18.0 with IQR of 16.0-19.0. Significant modest positive correlations were found between respondents' knowledge and attitude scores regarding food poisoning (r = 0.24, p < 0.001), knowledge and practice scores regarding food poisoning (r = 0.23, p < 0.001), and attitude and practice scores regarding food poisoning (r = 0.30, p < 0.001). Respondents with a higher education level and who live in a city were the only factors significantly associated with higher knowledge scores (p < 0.05). Attitude improved as educational level increased (p < 0.05) and income level increased (p < 0.05). Those of female gender and employed were statistically significantly associated with higher satisfactory hygienic practices in relation to the prevention of food poisoning (p < 0.05). CONCLUSIONS: Knowledge, attitude, and practices regarding food poisoning prevention are associated with each other and are affected by a complex interplay between socio-economic variables. The study highlights the need for health education programmes and general awareness campaigns that intend not only to enhance knowledge but also promote parents to practice food safety measures strictly and further strengthen their awareness level.

Older Adult Consumers' Attitudes and Perceptions of Risk, Control, and Responsibility for Food Safety in the Domestic Kitchen.

Although vast amounts of consumer food safety knowledge and self-reported data exist, attitudinal data detailing perceptions of risk, control, and responsibility are lacking. Such data relating to vulnerable groups, including older adults, are particularly scarce. Perception determination is essential in consumer food safety research to facilitate a comprehensive understanding of the cognitive factors that may impact behavior. Previous research has indicated a relationship between food safety perceptions and behavior. Perceptual data can inform the development of targeted food safety educational interventions. This study was conducted to ascertain older adult consumers' cognitive perceptions regarding food safety. Older adults (≥60 years, n = 100) participated in a computer-assisted personal interview to determine perceived risk, control, and responsibility associated with food safety. Although the potential severity of foodborne illness may be understood, the association between foodborne illness and domestic food preparation may be underestimated. Significant differences were found between perceived personal risk, control, and responsibility and the risks, control, and responsibilities of others ( P > 0.001). Older adults perceived themselves to have lower levels of risk than other individuals have, suggesting perceptions of optimistic bias and personal invulnerability. Perceived greater levels of personal control and responsibility, compared with those of others, suggest perceptions associated with the illusion of control. Correlations were evaluated between personal perceptions of risk, control, and responsibility ( P < 0.05). Low levels of risk were correlated with high levels of control. Those respondents ≥80 years of age perceived higher levels of risk and lower levels of control and responsibility. Cumulatively, older adult consumers expressed perceptions of invulnerability, optimistic bias, and the illusion of control regarding food safety. Such perceptions may undermine attempts to provide education regarding food safety. Food safety messages for this audience must be tailored to overcome such perceptions.

Food Safety Instruction Improves Knowledge and Behavior Risk and Protection Factors for Foodborne Illnesses in Pregnant Populations.

Objective This study compared knowledge and food-handling behavior after pathogen-specific (experimental treatment) versus basic food safety instruction (active control) presented during nutrition education classes for low-income English- and Spanish-language pregnant women. Methods Subjects (n = 550) were randomly assigned to treatment groups in two different locations in the United States. Food safety instruction was part of an 8-lesson curriculum. Food safety knowledge and behavior were measured pre/post intervention. Descriptive data were analyzed by Chi-Square or ANOVA; changes after intervention were analyzed by regression analysis. Results Knowledge improved after intervention in the pathogen-specific treatment group compared to active control, especially among Spanish-language women. Behavior change after intervention for the pathogen-specific treatment group improved for thermometer usage, refrigeration and consumption of foods at high risk for safety; however, all other improvements in behavior were accounted for by intervention regardless of treatment group. As expected, higher pre-instruction behavioral competency limited potential gain in behavior post-instruction due to a ceiling effect. This effect was more dominant among English-language women. Improvements were also linked to formal education completed, a partner at home, and other children in the home. Conclusions for Practice This study demonstrated that pathogen-specific food safety instruction leads to enhance knowledge and food handling behaviors that may improve the public health of pregnant women and their unborn children, especially among Spanish-language women. More importantly, food safety instruction, even at the most basic level, benefited pregnant women's food safety knowledge and food-handling behavior after intervention.

Food safety knowledge of undergraduate students at a Canadian university: results of an online survey.

BACKGROUND: Foodborne diseases are an important public health issue, and young adults are an important demographic to target with food safety education. Our objective was to assess the food safety knowledge of undergraduate students at a Canadian university, to identify potential areas for such education. METHODS: In February 2015, we conducted an online survey of 485 undergraduate students at a university in Ontario, Canada. We assessed various food-related factors, including cooking frequency and prior food handling or preparation education. We then modeled the relationship between 'overall knowledge score' and the demographic and food skills/cooking experience predictors using multivariable log-binomial regression, to determine factors associated with relatively higher proportions of correct responses. RESULTS: Respondents were, on average, 20.5 years old, and the majority (64.8 %) lived off campus. Students cooked from basic ingredients infrequently, with 3 in 4 doing so a few times a year to never. Students averaged 6.2 correct answers to the 11 knowledge questions. Adjusting for other important covariates, older age and being a current food handler were associated with relatively higher knowledge, whereas working/volunteering in a hospital and infrequent cooking were associated with relatively lower knowledge. Males in the Faculty of Science had relatively higher knowledge than females in the Faculty of Science, both of whom had relatively higher knowledge than all students in other Faculties. Among students who had never taken a food preparation course, knowledge increased with self-reported cooking ability; however, among students who had taken such a course, knowledge was highest among those with low self-reported cooking ability. CONCLUSIONS: Consistent with other similar studies, students in Faculties outside of the Faculty of Science, younger students, and those who cook infrequently could benefit from food safety education. Supporting improved hand hygiene, in particular clarifying hand washing versus hand sanitizing messages, may also be important. Universities can play a role in such education, including as part of preparing students for work or volunteer placements, or as general support for student health and success.

Listeriosis and Toxoplasmosis in Pregnancy: Essentials for Healthcare Providers.

Listeriosis and toxoplasmosis are foodborne illnesses that can have long-term consequences when contracted during pregnancy. Listeriosis is implicated in stillbirth, preterm labor, newborn sepsis, and meningitis, among other complications. Toxoplasmosis is associated with blindness, cognitive delays, seizures, and hearing loss, among other significant disabilities. Healthcare providers who understand the fundamentals of Listeria and Toxoplasma infection will have the tools to identify symptoms and high-risk behaviors, educate women to make safer decisions, and provide anticipatory guidance if a pregnant woman would become infected with either of these foodborne illnesses.

Control beliefs and engagement in hygienic and safety behaviours: the case of foodborne illness.

Foodborne illness is an ever-growing concern in public health. Studies found that conventional training is not enough to cause employees to apply the hygiene and safety measures. The present study explores control and fatalistic beliefs as potential factors for explaining engagement in preventive actions. Two-hundred and seventeen employees of a fast-food restaurant (75 % of all staff) answered a questionnaire assessing their control beliefs, fatalistic beliefs, risk perception, and engagement in hygienic and safety behaviours. The results validated our hypotheses. Control beliefs were positively related to engagement in hygienic and safety behaviours (b = 0.43, p < 0.001). The inverse relation was observed for fatalistic beliefs (b = - 0.24, p < 0.001). The perceived effectiveness of the prescribed measures seems to be the best predictor of engagement in preventive behaviours, followed by perceived self-efficacy. To increase adherence to preventive measures, it is recommended to enhance staff's self-efficacy and perceived effectiveness of these measures.

Use of Health Belief Model Variables To Examine Self-Reported Food Handling Behaviors in a Sample of U.S. Adults Attending a Tailgate Event.

Unsafe food handling behaviors are common among consumers, and, given the venue, individuals attending a tailgating event may be at risk for foodborne illness. The objective of this study was to measure the association between Health Belief Model variables and self-reported usual food handling behaviors in a convenience sample of men and women at a tailgate event. Participants (n = 128) completed validated subscales for self-reported food handling behaviors (i.e., cross-contamination, sanitation), perceived threat of foodborne illness (i.e., perceived severity, perceived susceptibility), and safe food handling cues to action (i.e., media cues, educational cues). Perceived severity of foodborne illness was associated with safer behaviors related to sanitation (r = 0.40; P < 0.001) and cross-contamination (r = 0.33; P = 0.001). Perceived severity of foodborne illness was also associated with exposure to safe food handling media cues (r = 0.20; P = 0.027) but not with safe food handling educational cues. A large proportion of participants reported that they never or seldom (i) read newspaper or magazine articles about foodborne illness (65.6%); (ii) read brochures about safe ways to handle food (61.7%); (iii) see store displays that explain ways to handle food (51.6%); or (iv) read the "safe handling instructions" on packages of raw meat and poultry (46.9%). Perceived severity of foodborne illness was positively related to both dimensions of safe food handling as well as with safe food handling media cues. Except for the weak correlation between media cues and perceived severity, the relationships between safe food handling cues and perceived threat, as well as between safe food handling cues and behaviors, were nonsignificant. This finding may be due, in part, to the participants' overall low exposure to safe food handling cues. The overall results of this study reinforce the postulate that perceived severity of foodborne illness may influence food handling behaviors.

Gaps in food safety professionals' knowledge about noroviruses.

Noroviruses (NoVs) are the most common etiologic agents of endemic and epidemic foodborne disease in the United States. Food safety professionals play an important role in protecting the public from foodborne illness. A survey of food safety professionals (n = 314) was conducted to characterize their knowledge of NoVs and to identify gaps in this knowledge. To recruit individuals, 25 professional organizations promoted the survey via their Web sites, newsletters, and/or e-mail distribution lists. The survey used true or false and open-ended questions to assess knowledge about NoVs, including attribution, transmission, and prevention and control strategies, including food handling practices. The online survey was available from mid-October 2012 to mid-January 2013. Of the 314 respondents, 66.2% correctly identified NoVs as one of the three most common causes of foodborne disease in the United States. Only 5.4% of respondents correctly identified the three most common settings for NoV infections, and 65.0% of respondents had the misperception that cruise ships are one of the three most common settings. Seventeen respondents (5.4%) answered all 20 true-or-false questions correctly, 33 respondents (10.5%) answered at least 19 of the 20 questions correctly, and 186 respondents (65.0%) answered at least 15 of the 20 questions correctly (i.e., a score of 75% or higher). The content domain in which respondents had the most incorrect answers was food handling practices. Thirty-eight percent of respondents incorrectly responded that it is safe for restaurant workers infected with NoVs to handle packaged food, food equipment, and utensils. About half of respondents did not know the recommended sanitizing solution for eliminating NoVs from a contaminated surface. The survey findings identified several important gaps in food safety professionals' knowledge of NoVs. The study results will inform the development of a Web-based educational module on NoVs to improve efforts to prevent the spread of NoVs in retail and institutional food establishments.

Knowledge, attitudes, and practices among border crossers during temporary enforcement of a formal entry requirement for Mexican-style soft cheeses, 2009.

Mexican-style soft cheese known as queso fresco (QF), which is often unpasteurized, has been implicated in outbreaks of foodborne illness in the United States. The U.S. Food and Drug Administration (FDA) exercises discretion in enforcement of noncommercial importation of cheese. To test control measures aimed at decreasing unlawful QF importation, in 2009 the FDA temporarily enforced a requirement for formal commercial entry for all cheeses over 5 lb (2.3 kg) at the San Diego-Tijuana border. Enforcement was combined with educational outreach. Border crossers importing cheese and those not importing cheese were surveyed at the beginning and end of the temporary enforcement period. Data collected included participant demographic information, knowledge of QF-associated health risks, and attitudes and practices regarding QF consumption and importation. We surveyed 306 importers and 381 nonimporters. Compared with nonimporters, importers had a lower level of knowledge regarding QF-associated health risks (P < 0.0001). Border crossers carrying cheese were more likely to have less education, be U.S. or dual residents, consume QF more frequently, and cross the border less often. Importation and consumption of unpasteurized QF remained prevalent among border crossers during the temporary enforcement period, and the level of knowledge regarding QF-associated risks remained low among these crossers. More vigorous, sustained messaging targeted at high-risk groups is needed to change behaviors. Definition and consistent enforcement of limits will likely be needed to reduce QF importation and the risk of QF-associated diseases along the U.S.-Mexico border; however, public health benefits will need to be balanced against the cost of enforcement.

Reporting of foodborne illness by U.S. consumers and healthcare professionals.

During 2009-2010, a total of 1,527 foodborne disease outbreaks were reported by the Centers for Disease Control and Prevention (CDC) (2013). However, in a 2011 CDC report, Scallan et al. estimated about 48 million people contract a foodborne illness annually in the United States. Public health officials are concerned with this under-reporting; thus, the purpose of this study was to identify why consumers and healthcare professionals don't report foodborne illness. Focus groups were conducted with 35 consumers who reported a previous experience with foodborne illness and with 16 healthcare professionals. Also, interviews with other healthcare professionals with responsibility of diagnosing foodborne illness were conducted. Not knowing who to contact, being too ill, being unsure of the cause, and believing reporting would not be beneficial were all identified by consumers as reasons for not reporting foodborne illness. Healthcare professionals that participated in the focus groups indicated the amount of time between patients' consumption of food and seeking treatment and lack of knowledge were barriers to diagnosing foodborne illness. Issues related to stool samples such as knowledge, access and cost were noted by both groups. Results suggest that barriers identified could be overcome with targeted education and improved access and information about the reporting process.

Analyzing consumers' reactions to news coverage of the 2011 Escherichia coli O104:H4 outbreak, using the Extended Parallel Processing Model.

This article describes and analyzes Flemish consumers' real-life reactions after reading online newspaper articles related to the enterohemorrhagic Escherichia coli (EHEC) O104:H4 outbreak associated with fresh produce in May and June 2011 in Germany. Using the Extended Parallel Processing Model (EPPM) as the theoretical framework, the present study explored the impact of Flemish (Belgian) online news coverage on consumers' perception of the risk induced by the EHEC outbreak and their behavioral intentions as consumers of fresh produce. After the consumers read a newspaper article related to the outbreak, EPPM concepts were measured, namely, perceived severity, susceptibility, self-efficacy, and affective response, combined with behavioral intentions to eat less fresh produce, to rinse fresh produce better, and to alert loved ones concerning the risk. The consumers' reactions were measured by inserting a link to an online survey below every online newspaper article on the EHEC outbreak that appeared in two substantial Flemish newspapers. The reactions of 6,312 respondents were collected within 9 days for 17 different online newspaper articles. Looking at the perceived values of the EPPM concepts, the perceived severity and the perceived susceptibility of the risk were, as expected, high. However, the consumers thought they could prevent the risk from happening, which stresses the importance of increasing consumers' knowledge of emerging food safety risks. Furthermore, analyses showed the moderating role of government trust and its influence on the way consumers perceived the risk, how worried they were, and their behavioral intentions.

Annual cost of illness and quality-adjusted life year losses in the United States due to 14 foodborne pathogens.

In this article we estimate the annual cost of illness and quality-adjusted life year (QALY) loss in the United States caused by 14 of the 31 major foodborne pathogens reported on by Scallan et al. (Emerg. Infect. Dis. 17:7-15, 2011), based on their incidence estimates of foodborne illness in the United States. These 14 pathogens account for 95 % of illnesses and hospitalizations and 98 % of deaths due to identifiable pathogens estimated by Scallan et al. We estimate that these 14 pathogens cause $14.0 billion (ranging from $4.4 billion to $33.0 billion) in cost of illness and a loss of 61,000 QALYs (ranging from 19,000 to 145,000 QALYs) per year. Roughly 90 % of this loss is caused by five pathogens: nontyphoidal Salmonella enterica ($3.3 billion; 17,000 QALYs), Campylobacter spp. ($1.7 billion; 13,300 QALYs), Listeria monocytogenes ($2.6 billion; 9,400 QALYs), Toxoplasma gondii ($3 billion; 11,000 QALYs), and norovirus ($2 billion; 5,000 QALYs). A companion article attributes losses estimated in this study to the consumption of specific categories of foods. To arrive at these estimates, for each pathogen we create disease outcome trees that characterize the symptoms, severities, durations, outcomes, and likelihoods of health states associated with that pathogen. We then estimate the cost of illness (medical costs, productivity loss, and valuation of premature mortality) for each pathogen. We also estimate QALY loss for each health state associated with a given pathogen, using the EuroQol 5D scale. Construction of disease outcome trees, outcome-specific cost of illness, and EuroQol 5D scoring are described in greater detail in a second companion article.

The role of psychological determinants and demographic factors in consumer demand for farm-to-fork traceability systems.

Traceability systems are an important tool (1) for tracking, monitoring, and managing product flows through the supply chain for better efficiency and profitability of suppliers, and (2) to improve consumer confidence in the face of serious food safety incidents. After the global bovine spongiform encephalopathy (BSE) crisis affected producers, consumers, trade, and the health status of animals and humans, new systems to help confirm the status of cattle products along the supply chain from farm to fork were implemented in many countries (Trautman et al. 2008 ). In this study, people's overall food safety beliefs are explored with the main objective of measuring the link between their food safety beliefs and their attitudes toward traceability. A comparison is made among English-speaking Canadians, French-speaking Canadians, and Japanese consumers. In the study, an Internet-based survey was used to collect data from nationally representative samples of the population in Canada-English (1275), Canada-French (343), and Japanese (1940) in the summer of 2009. Respondents' interests in traceability systems are clearly linked to their sense that the industry is primarily responsible for any food safety outbreaks. Moreover, it is clear that certain segments of the population in all samples feel strongly about the importance of farm to fork traceability in beef; thus, policymakers may wish to consider extending traceability beyond the point of slaughter as a way of encouraging beef sales in Canada.

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.