Food safety education: health professionals' knowledge and assessment of WIC client needs

Assessment of the knowledge, attitude, and practice of childbearing mothers in the geographically coastal region of Bangladesh for cleanliness and food safety of food security

Objectives

Household hygiene and food safety are essential parts of food security; better food safety and hygiene will help reduce the chances of illness for young children and family members rarely studied in the selected area of coastal Bangladesh. The study aimed to discover the knowledge, attitude, and practice levels for cleanliness, hygiene, and food safety in the household.

Methods

In this study, we employed a cross-sectional survey with simple random sampling to collect data from 384 childbearing mothers. The survey used the pretested, validated, and standardized (knowledge, attitude, and practice) questionnaire-model-based interview guide.

Results

According to our study analysis, the knowledge, attitude, and practice scores among mothers were inadequate for household cleanliness and hygiene management. In the area context, knowledge efficiency was related to family type (joint and nuclear). Family economic conditions strongly influenced mothers' attitudes and behavior toward knowledge, attitude, and practice score. Unemployed and illiterate mothers have lower knowledge, attitude, and practice scores. Educated mothers have better knowledge, attitude, and practice score compared to illiterate mothers (p < 0.014). Nuclear family knowledge, attitude, and practice attitude was much greater (p < 0.04) and wealthier families showed better practice (p < 0.001) toward cleanliness and food safety in the household level.

Conclusions

The study discovered the mothers' and household members' attention need to improve the knowledge, attitude, and practice toward proper hygiene and food safety at the household level of marginalized populations in coastal Bangladesh.

A review of Canadian and international food safety systems: Issues and recommendations for the future

In January 2019, the Safe Food for Canadians Act/Safe Food for Canadians regulations (heretofore identified as SFCR) came into force across Canada and brought a more streamlined process to food safety practice in Canada. Food trade and production processes have evolved rapidly in recent decades, as Canada imports and exports food products; therefore it is critically important to remain aware of the latest advances responding to a range of challenges and opportunities in the food safety value chain. Looking through the optics of the recent SFCR framework, this paper places the spotlight on leading domestic and international research and practices to help strengthen food safety policies of the future. By shedding some light on new research, we also draw attention to international developments that are noteworthy, and place those in context as to how new Canadian food safety policy and regulation can be further advanced. The paper will benchmark Canada through a review study of food safety best practices by juxtaposing (i) stated aspirations with, (ii) actual performance in leading Organization for Economic Cooperation and Development (OECD) jurisdictions.

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.

Food Safety Knowledge, Attitudes, and Behaviors of Native American Families with Young Children: A Mixed Methods Study

Children are at increased risk for foodborne illness due to underdeveloped immune system. Limited research has been reported on food safety knowledge of Native American families with children 10 years of age and younger. This study was conducted to determine the food safety knowledge, attitudes, and behaviors of the main food preparer in these families by collecting quantitative and qualitative data simultaneously in a mixed method approach. A food safety knowledge survey created using FightBAC!™ concepts was administered prior to focus groups discussions held in Native American communities using a script based upon the Health Belief Model. Quantitative data were analyzed using SPSS. Qualitative data were coded by three reviewers independently and then compared jointly for themes. Over three fourths of participants (n = 102) were female with an average age of 38.3 years. Over one half of participants were unemployed (54 %), lived on reservations (54 %), and 86 % had a high school degree or higher level of education. The following four themes emerged from the eight focus groups (n = 66): food can make one sick, I am not in control when others handle food, I know how to safely prepare foods for my family, and I do not have time or best equipment (for food safety). Mixed method analysis revealed that participants were aware of the severity and susceptibility for foodborne illness but were confident in preparing foods safely for their family. A food safety education program for Native American food preparers with young children is needed to prevent foodborne illness (FBI) in this population and promote safe food handling practice.

Listeriosis during Pregnancy: A Public Health Concern

Listeria was first described in 1926 by Murray, Webb, and Swann, who discovered it while investigating an epidemic infection among laboratory rabbits and guinea pigs. The role of Listeria monocytogenes as a foodborne pathogen was definitively recognized during the 1980s. This recognition was the consequence of a number of epidemic human outbreaks due to the consumption of contaminated foods, in Canada, in the USA and in Europe. Listeriosis is especially severe in immunocompromised individuals such as pregnant women. The disease has a low incidence of infection, although this is undeniably increasing, with a high fatality rate amongst those infected. In pregnant women listeriosis may cause abortion, fetal death, or neonatal morbidity in the form of septicemia and meningitis. Improved education concerning the disease, its transmission, and prevention measures for immunocompromised individuals and pregnant women has been identified as a pressing need.

Nurses and dietitians differ in food safety information provided to highly susceptible clients

OBJECTIVE

To determine content, education channels, and motivational factors that influence what health professionals teach about safe food handling to populations who are highly susceptible for foodborne illnesses. To assess the differences in information provided by health professionals to highly susceptible populations.

DESIGN

Descriptive, cross-sectional, Web-based survey.

SETTING

National convenience sample from across the United States.

PARTICIPANTS

Registered nurses (RNs; n = 232) and registered dietitians (RDs; n = 267).

MAIN OUTCOME MEASURE(S)

Content, motivation, and education channels used to educate highly susceptible populations.

ANALYSIS

Various nonparametric tests were applied to measure differences. Significance was declared at P < .05.

RESULTS

Although both RDs and RNs were providing some food safety information to their high-risk clients, RDs had more training than RNs in safe food handling and were more likely to provide comprehensive food safety messages to their highly susceptible clients; however, neither professional type provided consistent food safety information to patients at high risk for foodborne illness.

CONCLUSIONS AND IMPLICATIONS

There is a need for more information about what motivates the health professional to teach safe food handling and a need for a universally adopted, evidence-based practice for teaching safe food handling to patients at high risk for foodborne illness.

Trends in ownership and usage of food thermometers in the United States, 1998 through 2010

Food safety research has shown that the use of a food thermometer is the best way to ensure that meat, poultry, and other foods reach an internal temperature sufficient to destroy foodborne pathogens. The 1998, 2001, 2006, and 2010 Food Safety Surveys were used to analyze changes in food thermometer ownership and usage for roasts, chicken parts, and hamburgers in the United States. A probit regression model was used to evaluate differing trends in ownership across demographic subgroups, and probit models with sample selection were used to evaluate differing trends in food thermometer usage for roasts, chicken parts, and hamburgers. The Food Safety Surveys are nationally representative telephone surveys tracking consumers' food safety attitudes and behaviors. Findings from these surveys indicate that the percentage of consumers who own food thermometers has increased from 49% in 1998 to 70% in 2010 (P < 0.05). The use of food thermometers has also increased over this time period but varies by food type. Of those who own food thermometers, a higher percentage reported using thermometers for roasts (76% in 1998 and 82% in 2010, P < 0.05) than for chicken parts (33% in 1998 and 53% in 2010, P < 0.05) and hamburgers (14% in 1998 and 23% in 2010, P < 0.05). The results also show that men, non-Hispanic whites, those with some college education or higher, those with higher incomes, and those 65 years and older were more likely to own food thermometers. After controlling for food thermometer ownership, those aged 18 to 29 years were more likely to use a food thermometer for roasts and chicken parts than those aged 65 to 101 years. The results suggest that educational programs encouraging food thermometer usage should focus first on food thermometer ownership.

Food safety knowledge and practice by the stages of change model in school children

In this study, 342 grade 4-6 elementary school students in Gyeonggi-do were recruited to determine their readiness to change food safety behavior and to compare their food safety knowledge and practices by the stages of change. The subjects were divided into three stages of change; the percentage of stage 1 (precontemplation) was 10.1%, the percentage of stage 2 (contemplation and preparation) was 62.4%, and that of stage 3 (action and maintenance) was 27.5%. Food safety knowledge scores in stage 3 (4.55) or stage 2 (4.50) children were significantly higher than those in stage 1 children (4.17) (P < 0.05). The two food safety behavior items "hand washing practice" and "avoidance of harmful food" were significantly different among the three groups (P < 0.05). Stages of change were significantly and positively correlated with food safety knowledge and practice. Age was significantly and negatively correlated with the total food safety behavior score (r = -0.142, P < 0.05). The most influential factor on the stage of change was a mother's instruction about food safety (P < 0.01).

Diarrheal illness among women, infants, and children (WIC) program participants in Miami, Florida: implications for nutrition education

OBJECTIVE

To assess risk factors for diarrheal illness among clients of a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic in Miami, FL.

DESIGN

A cross-sectional survey with questions about demographics, food safety practices, and diarrheal illness.

SETTING

WIC clinic operated by the Miami-Dade County Health Department in Florida. WIC is a national program for nutritionally at-risk, low-income young children and pregnant or postpartum women.

PARTICIPANTS

WIC female clients at least 18 years of age who are able to read and speak English (n = 299).

MAIN OUTCOME MEASURE

Diarrheal illness, defined as having at least 3 loose stools for 2 or more consecutive days during the previous 30 days.

ANALYSIS

Univariate and multiple logistic regression analyses.

RESULTS

Food safety behaviors significantly associated with diarrheal illness included not washing hands before preparing meals (P = .048) and baby bottles (P = .045) or after changing diapers (P = .009) and not washing all items that touched raw meat before preparing the next food item (P = .023). In general, pregnant women reported less frequent hand washing and had a lower food safety score than nonpregnant women (P = .002).

CONCLUSIONS AND IMPLICATIONS

These findings suggest that interventions to improve food handling practices such as proper hand washing are needed for WIC clients, particularly pregnant women.

A qualitative study of the Australian midwives' approaches to Listeria education as a food-related risk during pregnancy

OBJECTIVE

to explore midwives' perceptions of food-related risks and their approaches to Listeria education during pregnancy.

DESIGN

an exploratory design within a qualitative framework.

SETTING

one private and two public hospitals in New South Wales, Australia.

PARTICIPANTS

10 midwives providing antenatal care in the selected hospitals.

FINDINGS

midwives had a range of approaches, from active to passive, to Listeria education. The main education provided was focused only on some of the high Listeria-risk foods with little education on safe food-handling practices. Midwives' perception of food-related risks was a function of their limited scientific knowledge and their reliance on their experiential knowledge and their common sense. System constraints such as temporal pressure, limited availability of educational materials and low adherence to Listeria recommendations within the health system were also identified to influence midwives' practice.

KEY CONCLUSIONS

professional practice guidelines regarding food safety and Listeria education are needed, together with relevant professional training and review of hospital practices in relation to this important health issue.

A pilot study describing infant formula preparation and feeding practices

Foodborne illnesses pose a problem to all individuals but are especially significant for infants. This observational study collected pilot data on formula preparation practices of 15 mothers of infants under the age of 7 months. A site survey tool was developed, based upon existing instruments. A trained observer traveled to the participants' homes to observe formula preparation and feeding. Some 73% of women did not wash their hands before preparing formula, 60% did not keep the prepared bottle cool during transport away from home, 53% checked the formula expiration date, 20% of infants slept with their bottle, 47% added cereal to formula, and 36% obtained information about formula preparation from a health professional. Hand washing is one of the most important home hygiene practices; however, hand washing practices by participants in our study prior to baby bottle preparation was poor.

Randomized controlled trial to determine the effectiveness of an interactive multimedia food safety education program for clients of the special supplemental nutrition program for women, infants, and children

BACKGROUND

Pregnant women and the very young are among those most susceptible to foodborne infections and at high risk of a severe outcome from foodborne infections.

OBJECTIVE

To determine if interactive multimedia is a more effective method than pamphlets for delivering food safety education to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clients.

DESIGN

A randomized controlled trial of WIC clients was conducted. Self-reported food safety practices were compared between pre- and postintervention questionnaires completed >or=2 months after the intervention.

SUBJECTS/SETTING

Pregnant WIC clients or female caregivers (usually mothers) of WIC clients who were 18 years of age or older and able to speak and read English were recruited from an inner-city WIC clinic.

INTERVENTION

Participants were randomized to receive food safety pamphlets or complete an interactive multimedia food safety education program on a computer kiosk.

MAIN OUTCOME MEASURES

Change from pre- to postintervention food safety scores.

STATISTICAL ANALYSES PERFORMED

A mean food safety score was determined for each participant for the pre- and postintervention questionnaires. The scores were used in a two-group repeated measures analysis of variance.

RESULTS

Of the 394 participants, 255 (64.7%) completed the postintervention questionnaire. Satisfaction with the program was high especially among those with no education beyond high school. When considering a repeated measures analysis of variance model with the two fixed between-subject effects of group and age, a larger improvement in score in the interactive multimedia group than in the pamphlet group (P=0.005) was found, but the size of the group effect was small (partial eta(2)=0.033). Women aged 35 years or older in the interactive multimedia group had the largest increase in score.

CONCLUSIONS

The interactive multimedia was well-accepted and resulted in improved self-reported food safety practices, suggesting that interactive multimedia is an effective option for food safety education in WIC clinics.

Desenvolvimento e reprodutibilidade de questionário para avaliar práticas e conhecimentos em segurança alimentar de nutricionistas da área clínica

OBJETIVO: Os propósitos deste estudo foram desenvolver um questionário para avaliar práticas e conhecimentos em segurança sanitária alimentar, de nutricionistas da área clínica, e medir o nível de reprodutibilidade deste questionário. MÉTODOS: O questionário foi desenvolvido a partir de seis áreas temáticas: prevenção da contaminação cruzada; higiene pessoal/ambiental; controle de temperaturas e de alimentos de alto risco e segurança alimentar para indivíduos portadores do vírus da imunodeficiência humana/síndrome da imunodeficiência adquirida. Para medir o nível de reprodutibilidade, utilizou-se o procedimento de teste e re-teste e a estatística kappa simples. RESULTADOS: Os resultados mostraram os níveis de reprodutibilidade: >0,61 para 95,0%; entre 0,60-0,40 para 2,5% e <0,40 para 2,5% das questões testadas. Oitenta por cento das questões apresentaram grau de acertos na faixa de 20,0%-80,0%. CONCLUSÃO: Os resultados mostraram que o instrumento apresenta grau de dificuldade adequado e um nível de reprodutibilidade satisfatório para a maioria das questões (Kappa>0,61), sugerindo que o mesmo representa uma boa opção para avaliar as práticas e os conhecimentos em segurança alimentar de nutricionistas da área clínica, visando ao planejamento de estratégias educativas.

Food safety practices among pregnant women and mothers in the women, infants, and children program, Miami, Florida

Pregnant women and infants are two groups at the highest risk of severe outcomes from foodborne illnesses. We surveyed adult clients of a Women, Infants, and Children (WIC) clinic serving predominately African Americans in inner-city Miami, Florida, to assess food safety practices. Eligible and consenting women completed a 23-item self-administered survey with questions concerning food handling practices around the Partnership for Food Safety Education's Fight BAC! campaign constructs of "clean", "separate" (not cross-contaminated), "cook", and "chill". Of 342 eligible clients, 299 (87.4%) consented to participate. In general, the clients' food safety practices were most problematic in the cook and chill constructs. Using a cooking thermometer, refrigerating foods within 2 h, and thawing them safely were the least commonly reported safe practices. Women who were pregnant with their first child had the lowest food safety practice scores. Of the 62 pregnant participants, 32 (51.6%) reported eating hot dogs or deli meats without first reheating them some of the time or more often, and 22 (35.5%) reported eating soft cheeses and blue-veined cheeses some of the time or more often, putting the women at risk of listeriosis. Although all women in the WIC program could benefit from food safety education, these findings indicate that women during their first pregnancy should especially be targeted for food safety education.

Food safety beliefs and barriers to safe food handling among WIC program clients, Miami, Florida

OBJECTIVE

To determine beliefs about and barriers to good food safety practices among clients of a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program).

DESIGN

Five audiotaped focus groups.

SETTING

A large WIC Program clinic in Miami, Florida.

PARTICIPANTS

Thirty-two women attending the clinic who were demographically similar to clinic clients.

PHENOMENON OF INTEREST

Beliefs about, barriers to, and motivators for good food safety practices.

ANALYSIS

Focus groups were audiotaped and transcribed. Transcripts were independently analyzed by three researchers to identify recurring ideas within and between groups.

RESULTS

Participants did not perceive foodborne illnesses as a major problem or believe that foodborne illnesses usually resulted from poor food handling practices at home. The hardest practice to follow was using a cooking thermometer. Leaving perishable foods and baby bottles outside the refrigerator for longer than 2 hours were additional problems reported. Participants reported that their babies' health was the most important motivator to good food safety practices and that women may be most receptive to food safety education during their first pregnancy.

CONCLUSIONS AND IMPLICATIONS

WIC clients in this clinic have several deficiencies in their food safety knowledge and practices. The WIC Program may be well positioned to help its clients, particularly pregnant women, improve food safety practices.