Sheryl Cates

Consumer Food Safety Knowledge, Practices, and Demographic Differences: Findings from a Meta-Analysis:

Risk communication and consumer education to promote safer handling of food can be the best way of managing the risk of foodborne illness at the consumer end of the food chain. Thus, an understanding of the overall status of food handling knowledge and practices is needed. Although traditional qualitative reviews can be used for combining information from several studies on specific food handling behaviors, a structured approach of meta-analysis can be more advantageous in a holistic assessment. We combined findings from 20 studies using meta-analysis methods to estimate percentages of consumers engaging in risky behaviors, such as consumption of raw food, poor hygiene, and cross-contamination, separated by various demographic categories. We estimated standard errors to reflect sampling error and between-study random variation. Then we evaluated the statistical significance of differences in behaviors across demographic categories and across behavioral measures. There were considerable differences in behaviors across demographic categories, possibly because of socioeconomic and cultural differences. For example, compared with women, men reported greater consumption of raw or undercooked foods, poorer hygiene, poorer practices to prevent cross-contamination, and less safe defrosting practices. Mid-age adults consumed more raw food (except milk) than did young adults and seniors. High-income individuals reported greater consumption of raw foods, less knowledge of hygiene, and poorer cross-contamination practices. The highest raw ground beef and egg consumption and the poorest hygiene and cross-contamination practices were found in the U.S. Mountain region. Meta-analysis was useful for identifying important data gaps and demographic groups with risky behaviors, and this information can be used to prioritize further research.

Cost Effectiveness of Zanamivir for the Treatment of Influenza in a High Risk Population in Australia

AbstractObjective: To use data from a clinical trial of zanamivir, a new antiviral drug, to estimate the costs and effectiveness of alternative treatment strategies for a high-risk population in Australia visiting a physician for treatment of influenza or influenza-like illness within 36 hours of symptom onset. Design and setting: This was a modelling study using data from a randomised, double-blind, placebo-controlled trial with centres in Australia, New Zealand and South Africa. Cost data were taken from standard Australian sources. Methods: Efficacy data from the clinical trial were used to populate a computer model designed to estimate the costs and health outcomes associated with alternative treatments for influenza and influenza-like illness. Only patients who consulted the physician within 36 hours of symptom onset were included in this trial. Cost data were used to translate the clinical data into treatment cost estimates. Results: Treatment with zanamivir for this high risk population results in an incremental cost of

Consumer Phase Risk Assessment for Listeria Monocytogenes in Deli Meats

A14.20 per day of symptoms avoided in the base case. The cost per quality-adjusted life-year (QALY) gained is

Pregnant Women and Listeriosis: Preferred Educational Messages and Delivery Mechanisms

A11 715. The results are sensitive to several parameter values, including the influenza-positive rate and the impact of zanamivir on days to alleviate symptoms and hospitalisation. Conclusions: Influenza is costly for the high risk population who seek physician treatment. Treatment with zanamivir for this population is cost effective based on an

Certified kitchen managers: do they improve restaurant inspection outcomes?

A78 000 per QALY benchmark. Zanamivir could be cost saving if it reduces the hospitalisation rate.

Consumer Home Refrigeration Practices: Results of a Web-Based Survey

The foodborne disease risk associated with the pathogen Listeria monocytogenes has been the subject of recent efforts in quantitative microbial risk assessment. Building upon one of these efforts undertaken jointly by the U.S. Food and Drug Administration and the U.S. Department of Agriculture (USDA), the purpose of this work was to expand on the consumer phase of the risk assessment to focus on handling practices in the home. One-dimensional Monte Carlo simulation was used to model variability in growth and cross-contamination of L. monocytogenes during food storage and preparation of deli meats. Simulations approximated that 0.3% of the servings were contaminated with >10(4) CFU/g of L. monocytogenes at the time of consumption. The estimated mean risk associated with the consumption of deli meats for the intermediate-age population was approximately 7 deaths per 10(11) servings. Food handling in homes increased the estimated mean mortality by 10(6)-fold. Of all the home food-handling practices modeled, inadequate storage, particularly refrigeration temperatures, provided the greatest contribution to increased risk. The impact of cross-contamination in the home was considerably less. Adherence to USDA Food Safety and Inspection Service recommendations for consumer handling of ready-to-eat foods substantially reduces the risk of listeriosis.

An Application of Meta-Analysis in Food Safety Consumer Research To Evaluate Consumer Behaviors and Practices

OBJECTIVE To characterize pregnant womens food safety practices, to evaluate the impact of existing educational messages on the risks and prevention of listeriosis, and to identify preferred delivery methods for educational initiatives. DESIGN Eight focus group discussions conducted with pregnant women in 4 locations. SETTING Focus group discussions led by moderators using a prepared moderator guide. PARTICIPANTS Purposeful sampling was used to select the 63 pregnant women who participated in this study. The focus groups were segmented by location and education level. PHENOMENON OF INTEREST Food safety knowledge and food-handling practices, food safety practices during pregnancy, attitudes toward listeriosis brochure, and preferred delivery methods. ANALYSIS Focus group discussions were videotaped and audiorecorded. Detailed summaries of each discussion were prepared and systematically analyzed to identify common themes within and across groups. RESULTS Participants were not aware of the risks of listeriosis and recommended practices for listeriosis prevention; thus, they were not taking precautions during their pregnancy to prevent listeriosis. CONCLUSIONS AND IMPLICATIONS The study identified the need to develop educational materials on listeriosis targeted specifically to pregnant women and to partner with obstetricians and other health care providers to deliver these materials to pregnant women.

Nutrition-Education Program Improves Preschoolers' At-Home Diet: A Group Randomized Trial

Restaurants are associated with a significant number of foodborne illness outbreaks in the United States. Certification of kitchen managers through an accredited training and testing program may help improve food safety practices and thus prevent foodborne illness. In this study, relationships between the results of routine restaurant inspections and the presence of a certified kitchen manager (CKM) were examined. We analyzed data for 4461 restaurants in Iowa that were inspected during 2005 and 2006 (8338 total inspections). Using logistic regression analysis, we modeled the outcome variable (0 = no critical violations [CVs]; 1 = one or more CVs) as a function of presence or absence of a CKM and other explanatory variables. We estimated separate models for seven inspection categories. Restaurants with a CKM present during inspection were less likely to have a CV for personnel (P < 0.01), food source or handling (P < 0.01), facility or equipment requirements (P < 0.05), ware-washing (P < 0.10), and other operations (P < 0.10). However, restaurants with a CKM present during inspection were equally likely to have a CV for temperature or time control and plumbing, water, or sewage as were restaurants without a CKM present. Analyses by type of violation within the temperature and time control category revealed that restaurants with a CKM present during inspection were less likely to have a CV for hot holding (P < 0.05), but the presence of a CKM did not affect other types of temperature and time control violations. Our analyses suggest that the presence of a CKM is protective for most types of CVs, and we identify areas for improving training of CKMs.

Consumer knowledge, storage, and handling practices regarding Listeria in frankfurters and deli meats : Results of a web-based survey

To reduce bacterial growth and to ensure the quality and safety of food products, the U.S. Department of Agriculture and the U.S. Food and Drug Administration advise consumers to clean their refrigerators regularly, use a refrigerator thermometer, and keep refrigerator temperatures at 40 degrees F (4.4 degrees C) or below. We conducted a nationally representative Web-enabled survey (n = 2,060) to collect data on refrigerator thermometer ownership, home refrigerator temperatures, and the frequency of home refrigerator cleaning. We stratified the sample to provide results for pregnant women, older adults (60 years or older), and the remaining population. About half of all respondents had cleaned their refrigerators at least 1 month before the survey. Only 11% of all respondents had a thermometer in their refrigerator before the survey. Older adults (77.5%) were more likely than the remaining population (70.4%) to have their refrigerators at the recommended temperature (P < 0.01). Older adults who were not married and who lived alone were less likely to have refrigerator thermometers and to have their refrigerators at a recommended temperature (P < 0.05). For all respondents, those who had previously owned a refrigerator thermometer were more likely to have their refrigerators at the recommended temperature than were respondents who did not previously own a thermometer (P < 0.01). Food safety educators can use the survey findings and results of previous research to target educational materials and help consumers, especially those at risk for listeriosis, to safely store refrigerated foods at home.

Consumer knowledge and use of open dates: results of a WEB-based survey.

Meta-analysis provides a structured method for combining results from several studies and accounting for and differentiating between study variables. Numerous food safety consumer research studies often focus on specific behaviors among different subpopulations but fail to provide a holistic picture of consumer behavior. Combining information from several studies provides a broader understanding of differences and trends among demographic subpopulations, and thus, helps in developing effective risk communication messages. In the illustrated example, raw/undercooked ground beef consumption and hygienic practices were evaluated according to gender, ethnicity, and age. Percentages of people engaging in each of the above behaviors (referred to as effect sizes) were combined using weighted averages of these percentages. Several measures, including sampling errors, random variance between studies, sample sizes of studies, and homogeneity of findings across studies, were used in the meta-analysis. The statistical significance of differences in behaviors across demographic segments was evaluated using analysis of variance. The meta-analysis identified considerable variability in effect sizes for raw/undercooked ground beef consumption and poor hygienic practices. More males, African Americans, and adults between 30 and 54 years (mid-age) consumed raw/undercooked ground beef than other demographic segments. Males, Caucasians, and Hispanics and young adults between 18 and 29 years were more likely to engage in poor hygienic practices. Compared to traditional qualitative review methods, meta-analysis quantitatively accounts for interstudy differences, allows greater consideration of data from studies with smaller sample sizes, and offers ease of analysis as newer data become available, and thus, merits consideration for its application in food safety consumer research.