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Persons with compromised immunity are at increased risk for serious foodborne infections that cause life-threatening complications. Health care providers should be able to explain this risk to patients and provide sound information on how to make safe food selection and preparation choices. 'Food Safety Issues for High Risk Populations,' an on-line continuing education course targeting nutrition and health educators, was developed by researchers at Colorado State, Ohio State, and Washington State universities. The course included 6 modules: introduction; immunology; pregnancy; HIV infection; cancer and transplants; and the life cycle. Modules included PowerPoint slides in PDF and Flash formats, audio, written scripts, and reference links. Outcomes were measured using pre- and postquestionnaires and a course evaluation. For each module, multiple-choice knowledge questions were developed and evaluated for content validity by course developers; the top 15 items were tested for reliability using the test-retest method. Ten items, per module, with strong test-retest correlations were selected as the final questions. Registered dietitians, nurses, and Extension educators were recruited through association listservs to pilot the course in fall 2004. Of the 141 who preregistered, 106 (75%) completed all modules. Participants who successfully passed the course received 6 credit hours from 1 of 3 professional associations. For each module, knowledge scores increased significantly (P < .001) from pre- to postquestionnaire. Overall, knowledge score increased from 67.3% pre to 91.9% post. Reported mean time spent per module was 48.2 minutes. On course evaluations, most participants indicated that all objectives were reasonably met. The project was funded by USDA-CSREES-NIFSI #2001-51110-11364.

Organ and stem cell transplant patients are at risk for foodborne illness due to disease and medically induced immunosuppression. The food safety knowledge and informational needs of these groups have not been documented in the literature. The objectives of this study were to assess transplant patients' food safety knowledge and perceptions, to probe the likelihood of practicing safe food handling behavior, and to test an educational strategy for future food safety interventions aimed at transplant patients. Subjects were organ or stem cell transplant patients, or their family care providers. Research was conducted in inpatient or outpatient facilities at a large, Midwestem United States comprehensive cancer and transplant center. Differences in survey data between the organ and stem cell transplant groups were determined by Student's t tests. Ethnographic methods were used to analyze qualitative focus groups and interview data for themes. Organ transplant patients had less motivation to follow food safety recommendations than did stem cell transplant patients, and they were more likely to consume risky foods. Stem cell transplant patients overall had a better understanding of their susceptibility to foodborne illness and had better prepared themselves with the knowledge and behavior changes needed to protect their health. Educational materials aimed at communicating food safety information for transplant patients were evaluated by patients and judged acceptable. This study found that organ transplant and stem cell transplant patients are distinct patient populations, with differing perceptions regarding the seriousness of foodborne illness and willingness to adopt preventative food handling practices. Population differences should be accounted for in food safety educational strategies. [ABSTRACT FROM AUTHOR]

Foodborne infections pose a threat to cancer patients who are immunocompromised because of disease or medical therapy. Comprehensive food safety education can raise cancer patients' awareness of risk for foodborne infections and encourage risk-reducing behavior. The objectives of this study were to assess food safety informational needs of cancer patients and to determine factors that may influence prospective educational interventions that foster risk-reducing behaviors. Focus groups with cancer patients were formed, and interviews with health professionals working with cancer patients were conducted. Findings were used to develop three educational resource prototypes for cancer patients. Information from two additional focus groups and interviews with cancer patients was used to evaluate the prototypes before revision and finalization. There was a general awareness among focus group participants that chemotherapy increased their susceptibility to foodborne illness and infections. Participants had a basic knowledge of safe food handling practices but did not necessarily link their awareness of increased susceptibility for infection with their routine food handling practices. When informed of specific high-risk foods, there was skepticism about compliance due to disbelief of the risk, personal preferences for the high-risk food, and lack of information about how to use the recommendation. Most of the health care providers agreed that food safety information should be provided by dietitians, physicians, and nurses, but physicians stated they had little time to do so. Cancer patients expressed positive attitudes toward the educational resource prototypes and willingness to follow the food safety recommendations provided. [ABSTRACT FROM AUTHOR]

An intervention to promote use of food thermometers when cooking small cuts of meat was conducted using the Transtheoretical Model. Objectives were to (i) increase use of food thermometers by home food preparers, (ii) improve consumers' attitudes regarding use of a food thermometer, and (iii) examine relationships between stages of change and decisional balance, self-efficacy, and processes of change. A randomly selected group of residents of Washington and Idaho (n = 2,500) were invited to participate in the research; 295 persons completed all phases of the multistep intervention. Following the intervention program, there was a significant increase in food thermometer use when cooking small cuts of meat (P « 0.01); those persons classified in action and maintenance stages increased from 9 to 34%. Ownership of thermometers also significantly increased (P « 0.05). The three constructs related to the Transtheoretical Model that were used in the study (decisional balance, self-efficacy, and processes of change) were very useful for examining differences among people at different stages of change because the responses for each set of questions differed positively and significantly (P « 0.01) as stages of change classifications advanced from precontemplation (no interest in thermometer use) to action and maintenance (individuals who use food thermometers). Additional educational campaigns designed to increase use of food thermometers are needed. Because most consumers are currently in the precontemplation stage, food thermometer campaigns will be most effective when they are focused on raising awareness of the food safety risks and the benefits of using food thermometers when cooking small cuts of meat. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The objective of this study was to design and develop food safety knowledge and attitude scales based on food-handling guidelines developed by a national panel of food safety experts. Design: Knowledge (n=43) and attitude (n=49) questions were developed and pilot-tested with a variety of consumer groups. Final questions were selected based on item analysis and on validity and reliability statistical tests. Subjects/setting: Knowledge questions were tested in Washington State with participants in low-income nutrition education programs (pretest/posttest n=58, test/retest n=19) and college students (pretest/posttest n=34). Attitude questions were tested in Ohio with nutrition education program participants (n=30) and college students (non-nutrition majors n=138, nutrition majors n=57). Statistical analyses performed: Item analysis, paired sample t tests, Pearson’s correlation coefficients, and Cronbach’s α were used. Results: Reliability and validity tests of individual items and the question sets were used to reduce the scales to 18 knowledge questions and 10 attitude questions. The knowledge and attitude scales covered topics ranked as important by a national panel of experts and met most validity and reliability standards. The 18-item knowledge questionnaire had instructional sensitivity (mean score increase of more than three points after instruction), internal reliability (Cronbach’s α >.75), and produced similar results in test-retest without intervention (coefficient of stability=.81). Knowledge of correct procedures for hand washing and avoiding cross-contamination was widespread before instruction. Knowledge was limited regarding avoiding food preparation while ill, cooking hamburgers, high-risk foods, and whether cooked rice and potatoes could be stored at room temperature. The 10-item attitude scale had an appropriate range of responses (item difficulty) and produced similar results in test-retest (P≤.01). Internal consistency ranged from α=.63 to .89. Students anticipating a career where food safety is valued had higher attitude scale scores than participants of extension education programs. Conclusions: Uses for the knowledge questionnaire include assessment of subject matter knowledge before instruction and knowledge gain after instruction. The attitude scale assesses an outcome variable that may predict food safety behavior. [Copyright &y& Elsevier]

A reliable and validated set of food safety behavior questions that could be used with confidence when evaluating food safety education programs was identified in this study. A list of 29 food-handling and consumption behaviors rank-ordered within five pathogen control factors by nationally recognized food safety experts was the basis for the development of the behavior questions. Questions were evaluated for reliability and several forms of validity. During a kitchen activity session, 70 graduates of a nutrition education program completed four food preparation tasks while being observed and videotaped. The individuals also participated in an in-depth interview to validate behaviors that could not be observed during the food preparation activity, e.g., refraining from preparing food for others when experiencing diarrhea. Criterion validity was established by comparing questionnaire responses to observed behavior and interview responses. Twenty-eight questions met the validity criterion (≥70% agreement between observed and interviewed responses and self-reported responses), with three or more questions from each of five pathogen control factor areas. Observation assessments revealed that hand washing was more likely to be performed prior to beginning food preparation than between working with raw meats and fresh produce. Errors in methods of washing hands, utensils, and preparation surfaces between food preparation tasks were common. Most participants did not use thermometers to evaluate doneness but still cooked to safe internal temperatures. The results provide a tool that educators can use to evaluate food safety programs and will help guide the development of more effective food safety education programs targeting needed improvements in behavioral skills. [ABSTRACT FROM AUTHOR]

To be effective in reducing the incidence of foodborne illness, consumers and food safety educators need information about behaviors that will decrease exposure to foodborne pathogens. A four-round Delphi technique was used to survey nationally recognized experts in food microbiology, epidemiology, food safety education, and food safety policy with the aim of identifying and ranking food-handling and consumption behaviors associated with 13 major foodborne pathogens. The food safety experts ranked behaviors related to keeping foods at safe temperatures as of primary importance in preventing illness caused by Bacillus cereus and Clostridium perfringens and of secondary importance in preventing illness caused by Staphylococcus aureus. The use of a thermometer to cook foods adequately was ranked as of primary importance for the prevention of illness caused by Campylobacter jejuni, Salmonella species, Escherichia coli O157:H7, Toxoplasma gondii, and Yersinia enterocolitica, with the avoidance of cross-contamination being ranked as of secondary importance for most of these pathogens. Hand washing was the top-ranked behavior for the prevention of shigellosis. The avoidance of certain foods that are likely to be contaminated was the top-ranked behavior for the prevention of illnesses caused by Listeria monocytogenes, Noroviruses, and Vibrio species. The expert panel's ranking of behaviors for the reduction of the risk of illness caused by major foodborne pathogens can enable consumers to make informed choices about food consumption and handling behaviors and can guide food safety educators in prioritizing their educational efforts. [ABSTRACT FROM AUTHOR]

The objective of this study was to evaluate the thermal inactivation of Escherichia coli O157:H7 in ground beef cooked to an internal temperature of 71.1°C (160°F) under conditions simulating consumer-style cooking methods. To compare a double-sided grill (DSG) with a single-sided grill (SSG), two different cooking methods were used for the SSG: for the oneturnover (OT-SSG) method, a patty was turned once when the internal temperature reached 40°C, and for the multiturnover (MT-SSG) method, a patty was turned every 30 s. Patties (100 g, n = 9) inoculated with a five-strain mixture of E. coli O157: H7 at a concentration of 10[sup 7] CFU/g were cooked until all three temperature readings (for two sides and the center) for a patty were 71.1°C. The surviving E. coli O157:H7 cells were enumerated on sorbitol MacConkey (SMAC) agar and on phenol red agar base with 1% sorbitol (SPRAB). The order of the cooking methods with regard to the cooking time required for the patty to reach 71.1°C was as follows: DSG (2.7 min) < MT-SSG (6.6 min) < OT-SSG (10.9 min). The more rapid, highertemperature cooking method was more effective (P < 0.01) in destroying E. coli O157:H7 in ground beef. E. coli O157:H7 reduction levels were clearly differentiated among treatments as follows: OT-SSG (4.7 log[sub 10] CFU/g) < MT-SSG (5.6 log[sub 10] CFU/g) < DSG (6.9 log[sub 10] CFU/g). Significantly larger numbers of E. coli O157:H7 were observed on SPRAB than on SMAC agar. To confirm the safety of ground beef cooked to 71.1°C, additional patties (100 g, n = 9) inoculated with lower concentrations of E. coli O157:H7 (10³ to 10[sup 4] CFU/g) were tested. The ground beef cooked by the OT-SSG method resulted in two (22%) of nine samples testing positive after enrichment, whereas no E. coli O157:H7 was found for samples cooked by the MT-SSG and DSG methods. Our findings suggest that consumers should be advised to either cook ground beef patties in a grill that cooks the top and the bottom of the patty at the same time or turn patties frequently (every 30 s) when cooking on a grill that cooks on only one side. [ABSTRACT FROM AUTHOR]

Traditionally, nutrition educators have used a fairly global approach to teach food safety by teaching a broad range of safe food handling behaviors in the expectation that this will lead to the avoidance of foodborne illness. This approach can be confusing and lead to evaluation data that are difficult to interpret. This article suggests that food safety education and evaluation in the future be organized around five behavioral constructs: practice personal hygiene, cook foods adequately, avoid cross-contamination, keep foods at safe temperatures, and avoid food from unsafe sources. These five constructs are derived from data on actual outbreaks and estimated incidences of foodborne illness. Research is needed to establish reliable and valid evaluation measures for these five behavioral constructs. Evaluation instruments can be tailored to fit specific education programs. If evaluation instruments focus on these five behavior areas, the result will be meaningful evaluation data that can be more easily summarized across food safety education programs for consumers. [ABSTRACT FROM AUTHOR]

Examines food safety education programs aimed at decreasing the risk of foodborne diseases among consumers. Five major control factors for pathogens; Incidence of foodborne diseases; Consumer behaviors regarding food handling at home.

Presents information pertaining to the companies which develop biotechnology-produced foods. Views of biotechnology critics; Information on the Netherlands involvement with biotechnology; Future prospects concerning the development of many food-related applications using biotechnology; Expression of some consumer organizations; Requirements of consumer involvement in policy making.

Identifies attitudes of Washington State residents regarding the nutritional benefits and cancer-preventing attributes of fruits and vegetables. Barriers to fruit and vegetable intake; Health Belief Model (HMB); Nutrition concern and susceptibility to cancer's relation to consumption.

Examines the roles of food and nutrition educators in food safety discussions. Questions on safety; Framework for evaluating food risks; Practices that potentially increase food-related risks.

Presents a study on consumer preferences for organic food and chemically treated food. Lack of consumer awareness of the implications of the environmental effects of pesticide use on their food choices; Greater awareness of consumers who are members of a cooperative of the benefits of organic foods than ordinary consumers; Other significant correlations of the study.

Surveys Washington state residents to assess their concern about pesticides and the relationship of this concern to their behavior. Instrument design and implementation; Respondent and construct characteristics; Analysis of construct scores; Attitudes related to concern about pesticides; Impact of attitudes about pesticides and the food supply on behavior.

Presents information on a study of the Abuela Project intervention which aimed to reduce foodborne illness, while preserving the Hispanic tradition of home preparation of cheese. Methodology; Results and discussion; Significance of the study.

This article highlights the health benefits of using food thermometers for checking the end-point temperature of small pieces of meat, such as hamburger patties and is recommended by the United States Department of Agriculture but is still uncommon among consumers. Most consumers rely on visual cues to judge the doneness of meat. In this regard, the authors of the article have developed a set of educational materials to educate and motivate consumers to routinely use a thermometer for small cuts of meat, with the long-term goal of reducing the incidence of foodborne illnesses, particularly Escherichia coli infections. The authors used the Transtheoretical Model (TTM) or Stages of Change theory to assess consumer readiness regarding use of food thermometers. TTM assumes that 5 stages, precontemplation, contemplation, preparation, action, and maintenance, are associated with behavior changes.

Abstract: Objective: To develop and evaluate the efficacy of an online continuing education course for professionals who provide food safety information to high-risk populations. Design: A 2-credit graduate-level class was converted into six web-based modules (overview of foodborne illness, immunology, pregnancy, human immunodeficiency virus, cancer and transplants, and lifecycle) and offered to nutrition and health professionals. Participants had 8 weeks to complete the modules, pre and post questionnaires, and course evaluation. Those who successfully completed the protocol received six continuing education units from one of three professional associations. Change in knowledge was measured using pre and post questionnaires. Course efficacy was evaluated using a post-course questionnaire. Subjects/setting: A convenience sample of 140 registered dietitians/dietetic technicians registered, nurses, and extension educators were recruited through professional conferences and electronic mailing lists to take the course. Statistical analyses: Analysis of variance was used to evaluate differences in knowledge scores for all groups across five main effects (attempt, module, profession, age, and education). Course evaluation responses were used to assess course effectiveness. Results: For each module, knowledge scores increased significantly (P<0.001) from pre to post questionnaire. Overall, knowledge scores increased from 67.3% before the modules to 91.9% afterwards. Course evaluation responses were favorable, and participants indicated that course objectives were met. Conclusions: Online continuing education courses, such as “Food Safety Issues for High Risk Populations,” seem to be a convenient, effective option for dietetics professionals, nurses, and extension educators seeking knowledge about food safety issues of high-risk populations. Online learning is a promising delivery approach for the continuing education of health professionals. [Copyright &y& Elsevier]

This study used a Web-based Delphi process with a group of nationally recognized food safety experts to identify food-handling behaviors of special importance in reducing the risk of foodborne illness among pregnant women, infants and young children, elderly people, and people with compromised immune systems because of disease or pharmacologic therapy. Behaviors were related to 13 pathogens. Top-rated behaviors for pregnant women were associated with Listeria monocytogenes, Toxoplasma gondii, and Salmonella species. Top-rated behaviors for infants and young children, elderly people, and immune-compromised people were associated with a number of different pathogens. The results should help dietetics professionals and community health educators focus their efforts on those behaviors of special importance to the population being targeted. [Copyright &y& Elsevier]

Abstract: Consumers’ readiness to use a food thermometer when cooking small cuts of meat was assessed using Prochaska’s Transtheoretical Model of Behavior Change. Face, content, and concurrent validity were assessed by peer review, cognitive interviews, and mail surveys. The self-administered mail survey was sent to two groups of Washington and Idaho residents: 1,000 randomly selected consumers (41% return rate), and 231 employees and volunteers of Cooperative Extension involved in food and nutrition education (60% return rate). Two-stage classification questions were compared with a behavior question about thermometer use, and validated using Cronbach’s if-item-deleted option for α. Concurrent validity was assessed using cross-tabulation χ2 test. The detailed classification question more accurately classified respondents in both Consumer and Extension groups. Cronbach’s α of the detailed question with the behavior question showed a consistency level of α=.73 compared to α=.35 for the simple question format. As expected, Consumer and Extension groups differed significantly in their stages of change (P<0.0001), verifying concurrent validity. We recommend use of the detailed classification question when staging persons related to food thermometer use. The process used for development and testing can be used to refine instruments for use in other types of interventions. [Copyright &y& Elsevier]

Abstract: Individuals with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome have an increased risk of contracting foodborne illnesses and need to take special precautions regarding food safety. We implemented a five-step model to assess the needs of people with HIV, develop education materials targeted to their needs, and evaluate acceptance of the materials. Needs assessment focus groups (n=8) with HIV-infected people (n=65) and interviews with health care providers (n=18) were conducted to determine motivators and barriers to adopting food safety recommendations. Education materials were developed using needs assessment data, literature on foodborne illnesses, and the Health Belief Model. Acceptability of materials was evaluated by focus groups (n=4) with HIV-infected people (n=32) and a survey of health care providers (n=25). Needs assessment focus group participants expressed resistance to and confusion about many recommendations. Prototype materials were designed to address barriers and motivators. HIV-infected people who reviewed the prototype materials in evaluation focus groups expressed positive attitudes about the materials, and most indicated willingness to follow recommendations. Health care providers were interested in distributing the education materials to their clients. Carefully listening to HIV-infected people and their health care providers, as well as detailed investigation of the literature on foodborne illnesses, contributed to acceptance of the education materials. [Copyright &y& Elsevier]