Food safety education for people with diabetes and pregnant women: A positive deviance approach

Quantitative microbiological risk assessment for the occurrence of listeriosis in Brazil due to the consumption of milk processed by pasteurization or thermosonication

This study aimed to estimate the risk of listeriosis from the consumption of pasteurized milk in Brazil, comparing conventional treatment with the technology of thermosonication. The Quantitative Microbiological Risk Assessment (QMRA) model was developed, covering the entire milk production chain, from milking to the moment of consumption. In general, higher risks were observed in association with higher initial concentrations of the pathogen and the vulnerable population. The highest risk predicted (3.67 × 10-5) was related to the scenario considering the initial concentration range of L. monocytogenes between 4 and 6 log CFU/mL, with conventional treatment and considering the vulnerable population, resulting in one case of listeriosis every 27,248 servings. When considering thermosonication treatment, lower risks have been predicted. The scenario analysis indicated that the steps related to storage conditions in retail and at the consumer's home (post-processing steps) are the most influential in the associated risk, in all scenarios. The predictive parameters of inactivation related to the applied treatment also have a considerable influence on the risk. The results point to the influence of the stages of the dairy production chain and the thermosonication treatment applied in the food safety of milk, subsidizing information for industrial application and for regulatory agencies.

Examining Safe Food-Handling Knowledge, Behaviour, and Related Psychological Constructs among Individuals at Higher Risk of Food Poisoning and the General Population

Safe food-handling knowledge and behaviour are low across the general population. This raises concerns about whether individuals at higher risk of food poisoning have sufficient safe food-handling knowledge and engage in safe food-handling practices. The aim of this study was to explore safe food-handling knowledge, behaviour, and related psychological constructs among individuals at higher risk of food poisoning and compare the results to the general population. Participants (N = 169) completed measures of safe food-handling knowledge, intention, habit strength, perceived risk, self-efficacy, subjective norms, and behaviour. A series of multivariate analyses of variance were conducted to determine differences in these measures between participants at higher risk of food poisoning and the general population. No significant differences in knowledge, intention, habit strength, self-efficacy, subjective norms, and behaviour were found between individuals at higher risk of food poisoning and the general population. However, individuals at higher risk of food poisoning appeared to have stronger risk perceptions across safe food-handling behaviours compared with the general population. This study demonstrated that individuals at higher risk of food poisoning do not have higher safe food-handling knowledge than the general population, and despite having higher risk perceptions around some safe food-handling behaviours, they do not differ in engagement in safe food-handling behaviours or the majority of related psychological constructs. Implications of these findings relate to the need to target other psychological constructs, not just risk perceptions, in order to see safer food-handling behaviours in high-risk populations.

Hand hygiene practices during meal preparation-a ranking among ten European countries

BACKGROUND

The aim of this paper was to map consumers' food hygiene practices from 10 European countries and evaluate which demographic groups are more likely to be exposed to foodborne pathogens and establish a ranking of adherence to food hygiene practices in 10 European countries.

METHODS

The research design consisted of a cross-national quantitative consumer survey regarding food safety and hygiene practices during meal preparation (SafeConsume project) and was conducted in ten European countries (France, Denmark, Germany, Greece, Hungary, Norway, Portugal, Romania, Spain and UK). The survey questions were based on recommended hand hygiene practices and on observed practices from a field study performed in 90 European households from six of the countries covered by the survey (France, Hungary, Norway, Portugal, Romania, and UK). SPSS Statistics 26 (IBM Software Group, Chicago, IL) was used for the descriptive and regression analyses of the data. Regression analyses were used to check the relation between demographic characteristics, country of origin and self-reported hand hygiene practices.

RESULTS

According to the regression models, families with elderly members aged over 65 showed a higher tendency to follow proper hand washing practices compared to families without elderly members. Meanwhile, families with children under the age of 6 reported being up to twice as likely to wash their hands at critical moments compared to families without children. Overall, taking into consideration the likelihood of washing hands after touching raw chicken and the percentages scores for proper hand cleaning methods and key moments for hand washing, the rank of the countries regarding proper hand hygiene practices was the following: Denmark, Greece, Norway, Romania, Hungary, Germany, UK, Portugal, France, and Spain.

CONCLUSIONS

Information and education should point both at the key moments as suggested by the Royal Society for Public Health (RSPH) and the International Scientific Forum on Home Hygiene (IFH) and safe practices. Public health burden generated by improper hand washing may be significantly reduced if education is targeted on consumers' behaviour and practices.

Identifying nutrition-sensitive development options in Madagascar through a positive deviance approach

Context-adapted interventions are needed to alleviate the burden of food and nutrition insecurity on resource-poor rural households in southeastern Madagascar. The Positive Deviance approach implies identifying locally viable development solutions by focusing on particularly successful, innovative individuals. To identify promising practices that could be promoted as part of food and nutrition security (FNS) interventions in the Atsimo Atsinanana region of southeastern Madagascar, positive deviance was searched among smallholder farmers. Positive deviants are defined as households with overall optimal performance across four aspects of FNS: household-level food security, women’s diet quality, child’s diet quality, and low diarrhea incidence. To identify positive deviants, a two-step procedure was followed. Based on quantitative survey data from 413 rural smallholder households (mother-child pairs) with a child aged between 6 and 23 months, each household’s four performance scores were adjusted by removing the average effects of household resources. Then, households with Pareto-optimal performance were identified regarding the four aspects. Subsequently, 16 positive deviants were revisited and positive deviant practices were identified through in-depth interviews. A set of practices were validated through focus group discussions with local nutrition and agriculture experts. Positive deviant practices include the adoption of agricultural innovation, such as new cash crops, as well as nutrition-sensitive market behaviors and reliance on off-farm activities. In addition, some ethno-cultural factors help to explain positive deviance. These diverse positive deviant practices may serve as examples and inspiration for locally grounded development interventions targeting FNS in southeastern Madagascar.

Positive deviance in health and medical research on individual level outcomes - a review of methodology

BACKGROUND

Positive deviance as a methodology is increasing in application yet there is high variability in how this approach is applied in health services research.

METHODS

We conducted a scoping review of the literature for positive deviance applied to health outcomes informed by PRISMA-ScR. We searched the literature from 1945 to 2020, including articles on positive deviance or positive outliers, and restricted to examining individual rather than organizational outcomes. We analyzed the methodology applied including the process of identifying deviants, the use of control groups, and the degree of community engagement.

RESULTS

Our initial search identified 1140 manuscripts; we included 104 papers describing 98 studies, 11 topical and one miscellaneous category. Most studies used objective measures of health or survey-based responses to identify deviants from a sub-set of the population at risk. The use of controls was less common in some topics (hospital infections), whereas controls were universally applied in other topics (malnutrition). The degree of community engagement varied widely.

CONCLUSIONS

Positive deviance would benefit from improvements in reporting and standardized approaches to defining deviance. Studies could be improved through clarified definitions of deviance/risk, explicit descriptions of community engagement, and more consistent use of controls.

An Evaluation of a Virtual Food Safety Program for Low-Income Families: Applying the Theory of Planned Behavior

Low-income families are reported to have a limited knowledge of food safety and resources to follow food safety practices compared with the rest of the population. This paper evaluated a virtual food safety educational program targeting food handlers in low-income families. Trained native speakers of English and Spanish delivered course materials in both languages. A total of 60 individuals participated in the program, with 30 participants in each language group. Most were female, and most had fewer than three children. After the program, participants’ food safety knowledge and self-reported safe food practice behavior scores increased significantly from 5.32 to 7.43 (out of 8.00) and from 24.78 to 29.30 (out of 35.00), respectively. The theory of planned behavior (TPB) was used to understand individuals’ behavior change intention of food safety practices. All the TPB constructs’ scores, including attitudes toward the behavior, perceived behavioral control, subjective norms, and behavior change intentions, were improved significantly; however, only the subjective norms and perceived behavioral control were significantly correlated with the behavior change intentions. This virtual educational program improved low-income individuals’ food safety knowledge and changed their food safety attitudes and behaviors, giving a path to develop and evaluate more virtual food safety educational programs in the future.

Disruptive Technologies for Achieving Supply Chain Resilience in COVID-19 Era: An Implementation Case Study of Satellite Imagery and Blockchain Technologies in Fish Supply Chain

In supply chains where stakeholders belong to the economically disadvantaged segment and form an important part of the supply chain distribution, the complexities grow manifold. Fisheries in developing nations are one such sector where the complexity is not only due to the produce being perishable but also due to the livelihood dependence of others in the coastal regions that belong to the section of economically disadvantaged. This paper explains the contextual challenges of fish supply chain in a developing country and describes how integrating disruptive technologies can address those challenges. Through a positive deviance approach, we show how firms can help unorganized supply chains with economically disadvantaged suppliers by carefully redesigning the supply chain through the integration of satellite imagery and blockchain technology. With COVID-19 in the backdrop, we highlight how such technologies significantly improves the supply chain resilience and at the same time contributes to the income generating opportunities of poor fisherfolks in developing nations. Our study has important implications to both developing markets and food supply chain practitioners as this paper tackles issues such as perishability, demand-supply mismatch, unfair prices, and quality related data transparency in the entire value chain.

Unstandard Deviation: The Untapped Value of Positive Deviance for Reducing Inequalities

Behavioral science is increasingly used in public policy to understand and address various manifestations of inequalities. Yet evidence from effective population-level interventions is limited. One framework, known as positive deviance, emphasizes individuals from disadvantaged circumstances who have significantly better outcomes than are typical for their group. Studying their behaviors and outcomes helps to understand what might explain their overall success. These insights could also be used to help others from these circumstances experience positive outcomes. Because positive deviance has been markedly understudied, we present a framework for doing so specifically within behavioral science for public policies aimed at reducing inequalities. Using examples from real-world and experimental insights on choices and outcomes of positive deviants, we encourage further study of their choices and trajectories over time to produce valuable insights. We propose that leveraging those findings would inform public policy by introducing interventions that are more ecologically sound and population-relevant and thus have a better chance at benefiting those who start off under adverse circumstances.

Chlorine Rechargeable Halamine Biocidal Alginate/Polyacrylamide Hydrogel Beads for Improved Sanitization of Fresh Produce

Traditional fresh produce washing systems mainly rely on mechanical forces and usage of chlorine bleach solutions to aid in removal and sanitization of microorganisms attached on surfaces of fresh produce during washing processes. Frequent outbreaks of foodborne diseases from ready-to-eat produce indicate insufficient sanitization of the washing processes. Herein, we present a scalable methodology for creating antimicrobial and chlorine rechargeable hydrogel beads using an in situ formed network of polyacrylamide and natural polysaccharide alginate through an emulsion polymerization. The resulting hydrogel beads exhibited robust mechanical strength, rechargeable chlorination capability, rapid up to 99.99% bacterial killing efficiency, and high produce sanitizaiton efficiency, enabling the hydrogel beads as a promising additive in chlorine sanitization to effectively sanitize the produce and automatically being recharged and reused.

Consumer Knowledge and Behaviors Regarding Food Safety Risks Associated with Wheat Flour

ABSTRACT

Consumers do not consider flour, a low-moisture food product, a high risk for microbial contamination. In the past 10 years, however, flour has been identified as a source of pathogenic bacteria, including Salmonella and Escherichia coli. Online surveys were conducted to study consumers' flour handling practices and knowledge about food safety risks related to flour. The survey also evaluated message impact on three food safety messages in communicating information and convincing consumers to adopt safe flour handling practices. Flour-using consumers (n = 1,045) from the United States reported they used flour to make cakes, cookies, and bread. Most consumers stored flour in sealed containers. Less than 1% kept a record of product identification numbers, such as lot numbers, and less than 11% kept brand and use-by date information. Many consumers (85%) were unaware of flour recalls, or outbreaks, and few (17%) believed they would be affected by flour recalls or outbreaks. If the recall affected the flour they bought, nearly half of the consumers (47%) would buy the same product from a different brand for a few months before they returned to the recalled brand. Among consumers who use flour to bake, 66% said they ate raw cookie dough or batter. Raw dough "eaters" were more difficult to convince to avoid eating and playing with raw flour than "noneaters." Food safety messages were less impactful on those raw dough eaters than noneaters. Compared with the food safety message with only recommendations, those messages with recommendations and an explanation as to the benefits of the practice were more effective in convincing consumers to change their practices. These findings provide insight into effective consumer education about safe flour handling practices and could assist in the accurate development of risk assessment models related to flour handling.

HIGHLIGHTS

Evaluation of the Fight BAC! The Story of Your Dinner Campaign Video: A Multistate Study

ABSTRACT

This study was conducted to evaluate the effectiveness of the holiday food safety campaign, "The Story of Your Dinner," launched in 2016 by the Partnership for Food Safety Education. The campaign was designed to change knowledge, risk perception, and perceived behavioral control ideas among U.S. consumers. Results from the study, conducted from 2016 through 2018, were analyzed overall and among specific demographic groups. For respondents from all 3 years, overall knowledge significantly increased from presurvey to postsurvey. Survey findings indicated that after viewing the educational intervention, adult respondents were significantly more confident in their ability to use a food thermometer while cooking small cuts of meat and poultry and developed a significantly higher perception of the risk of suffering from foodborne illness. The educational intervention was more effective for changing risk perception and perceived behavioral control among some demographic groups. Respondent risk perception and perceived behavioral control significantly increased in more categories for adolescents than for adults. Consumers tended to overestimate their safe food handling practices. Prior to the educational intervention, adult respondents rated themselves highly (5.49 ± 1.64 of 7.00) on their confidence in cooking meat and poultry that is safe to eat. However, these respondents were less comfortable complying with the safe food handling practice of using a thermometer on small (4.47 ± 1.98) and large (4.61 ± 2.02) cuts of meat and poultry. More educational interventions are needed to improve compliance with safe food handling in home kitchens. Future studies will be conducted to identify and address barriers to food safety behavioral change among various population groups.

HIGHLIGHTS

Motivators and Barriers to Cooking and Refrigerator Thermometer Use among Consumers and Food Workers: A Review

Temperature control prevents the rapid growth of foodborne pathogens during food storage and assures adequate heating to destroy pathogens prior to consumption. The use of thermometers is a recognized best practice among consumer and food worker guidelines; however, compliance with this recommendation is quite low. Eighty-five studies from the past 21 years were reviewed and an analyzed for the knowledge, attitudes, and behaviors associated with thermometer use and the motivators and barriers to cooking and refrigerator thermometer use among consumers and food workers. Barriers to thermometer were categorized into two major groups: "the belief that a thermometer is not necessary" and "the difficulty of selecting and using a thermometer." Each group has its unique aspects. Four barriers were recognized in the "not necessary" group: (i) preference for alternative techniques, (ii) mainstream media and food professionals seldom serve as role models and often negate the need for food thermometers, (iii) limited awareness of potential health issues associated with current practices, and (iv) limited knowledge and awareness related to thermometer usage for specific food groups. Six barriers were recognized in the "difficult to select and use" group: (i) difficulties in selecting the type of food thermometers, (ii) availability of food thermometers, (iii) lack of skills related to the usage of food thermometers, (iv) limited knowledge related to endpoint temperatures, (v) inability to calibrate food thermometers, and (vi) lack of knowledge about food thermometer cleaning and sanitation. These findings will facilitate the development and adoption of effective strategies to increase thermometer use and increase food safety education efficacy with a positive impact on public health.