Designing effective food safety messages

Dr. Ben ChapmanFood safety extension specialistDept of 4-H Youth Dev and FCSNorth Carolina State Universitybenjamin_chapman@ncsu.edu

Food-as-foe

Travis Cudney2010 Champion Child

Blind since age 2Complications from a

pathogenic E. coli infection

In-the-home

Processors

Retail and food service

Farmers

Transport

WHO factors contributing to foodborne illness• Improper cooking procedures• Temperature abuse during storage• Lack of hygiene and sanitation by food handlers• Cross-contamination between raw and ready-to-eat

foods• Foods from unsafe sources

o All human factors, behaviour basedo WHO, 2002

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Food safety communication philosophy• Anyone who tries to make a distinction

between education and entertainment doesn`t know the first thing about eithero Marshall McLuhan, 1967

• Disconnect between knowledge and food handler practices

o Green et al., 2006; Green and Selman, 2005; Pragle et al., 2007; Redmond et al., 2004

Foodnet 2008• U.S. CDC: New methods in communication

and education needed to address foodborne illnesses.

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From the literature• Using stories and narratives better than statistics alone

o Cole, 1998; Cole, 1997; Howard, 1991; Leventhal, 1970; Morgan et al., 2002; Slater and Rouner, 1996

• Put food safety into contexto Leventhal et al., 1965; Lordly, 2007

• Generate dialogueo Ajzen, 1991; Bohm et al., 1993; Dignum et al., 2001; Schein,

1993

• Surprising messageso Shannon, 1948

The four R’s of food safety communication• Rapid• Reliable• Relevant• Repeated

Risk communication

• Risk communication is two way exchange of information.

• Risk communication involves listening to, and interacting with, media, the public, experts, vested interests, and stakeholders.

• Risk is value laden.

What makes a good food safety story?• Risk/illnesses/deaths• Unknown• Imports

o US: One in four Americans "very worried" by China imports, New York Times, September 19, 2007

• Regulation/government• Trade/politics• Lawsuits

Why did my grandmother overcook pork?

Media’s impact• Covello’s four-hit theory of belief formation• First 48 hours of exposure to a new concept• Opinions are changed to concrete beliefs• Rationalize away conflicting info

Attitude towardsbehavior

Subjective norm

Perceived behavioral control

Intention Behavior

Theory of planned behavior, Ajzen, 1988

Risk communication

ScientificAssessment

of Risk

InformationVacuum

Public Perception

of Risk

Need to be able to addressWhat you are doingWhy you have risk reduction practicesUpdate often

In absence, it gets filled by… whomever

Powell, 1997

What does “safe” mean• Is it a guarantee?• What are consumers’ responsibilities to

reduce risk

How to best communicate food safety risks

Common consumer actions• Washing meat to remove pathogens• Thawing on the counter• Cooking until juices run clear• Washing produce with soap

The food system

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Spinach outbreak 200 people, 26 states, 4 dead

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Pathogen Cycle in Vegetable Production (Beuchat, 1998)

Risk Management Cycle Problem/

Context

Risks

Options

Decisions

Actions

EvaluationEngage

Stakeholders

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Grower

Packer

Shipper/Dealer

Farmers’ market/Food terminal

RetailOutlet

DistributionCentre

Foodservice

Consumer

Processor

Grower Grower

Grower/Packer

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Measuring behavior indicators• Inspections

o Not good indicators Cruz et al., 2001, Jones et al., 2004• Violations of temperature control most strongly

associated with outbreakso Irwin et al., 1989o Or just easiest to inspect for (resulting in more violations

recorded?)• Self-reported behavior• Significant deviations between stated and actual behavior

o DeDonder et al.; 2008; Jay et al., 1999; Clayton and Griffith 2003; Redmond et al., 2004

What do people actually do?

Retail/Food service

Why concentrate on food handlers• Asymptomatic food handlers are problematic

o 12% (129 of 1,033) of foodworkers tested positive for Salmonella. Sixty-four (53%) of 121 Salmonella-positive foodworkers reported not having had a recent gastrointestinal illness (Hedberg et al., 2006)

• Hepatitis A • Front line individuals responsible for

sanitation, preparation, hygiene

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Importance of foodservice• In 2008, U.S. food service sales totaled $566 billion (~$0.48 of

every food dollar)o NRA, 2009

• Up to 70 per cent of foodborne illnesses are sourced from restaurants

o Lee and Middleton, 2003; Jones and Angulo 2006; Olsen et al., 2000; Todd, 1998

• 816 outbreaks 80,682 cases (1927-2006) related to food handlers o Greig et al., 2007

• Lawsuits exceeding $80 milliono Buzby, 2003; Marler, 2005

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What have we seen food handlers do?Clayton and Griffith, 2004 BFJ• Observation

o 115 food handlers, observed on three occasionso 345 observationso 31,050 food safety actions

• Hand hygiene mistakes most prevalent• Only 16% of food handlers had correct practices all

the time • Not attempted 55% of the time

o Leading to cross-contamination potentialo Inadequate drying (44%) No use of soap (39%)

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Roberts et al., 2008 FPT• 3 hour observation with 177 food handlers• Baseline data• Proper handwashing compliance

o 16% washed after handling raw, potentially contaminated foods

o 93% dried with paper towel or hand dryer o 36% washed hands for 20 seconds

• Cross-contaminationo 15% food contact surfaces were cleaned after

potential contamination

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Video observation at foodservice(Chapman et al., JFP 2010)• Major international foodservice company• Approval by research ethics board• Staff knew there was recording

o But didn’t know exactly what for until following the recording

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Data collection• Direct cross-contamination

o Where a ready-to-eat (RTE) food is potentially contaminated through direct contact with a contaminant or raw food containing a contaminant

• Indirect cross-contamination o Where contaminants are passed to RTE food

through intermediate objects (such as equipment, food contact surfaces or hands).

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Data collection• Handwashing (correct)

o Watero Soapo Lather*o Rinseo Drying with paper towelo *length of time and water temperature were left

out due to not being evidence-based recommendations (Snyder, 1999).

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Results: Mean events per food handlerEvent Pre

(13.4 hrs)Post(13.5 hrs)

Change percentage

Handwashing attempts

21.1 22.5 +1.42* +6.7%

Correct handwashing events

2.4 4.0 +1.64* +68.9%

Indirect cross-contamination

15.7 13.1 -2.57* -19.6%

Direct cross-contamination

1.9 1.0 -0.85* -81.7%

*Significance level (p <.05, 95% CI)

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What do food handlers actually do?• Indirect cross-contaminate• Don’t really directly cross-contaminate• Increase risks when busy• Inconsistient hand hygiene

o Don’t dry hands (two studies)o Soap use (two studies)o Organizational food safety culture o Definitions of correct handwashing conflict

• Typical employee o Under 30 years of age

(52%)o High school graduate or

less (65%)o Part-time employee,

working average of 24.8 hours/week

o Individual with a relatively short job tenure

Source: National Restaurant Association, 2006

Foodservice employee profile

What do consumers do?

What do consumers do?• Video observation study of Australian

domestic food-handling practices • 47% of the individuals observed did not wash

their hands after handling raw meats• When they did wash, they washed without

soap (44%)o (Jay, 1999).

• A few studies that have assessed actual food-handling behaviors

• Consumers make many food-handling errors during food preparation, thus increasing their risk of foodborne illnesso (Anderson, Shuster, Hansen, Levy, & Volk, 2004;

Redmond & Griffith, 2003).

Consumer perception matters• Food contamination/outbreaks don’t always

resonate with consumers• Covello’s four-hit theory of belief formation

o (Covello, 1992)

Similar appearance of fully cooked and uncooked breaded products

Product packaging of fully cooked vs. uncooked products

Cause for consumer confusion?

Methods• Convenience sample

o 21 Primary meal preparers o 20 Adolescents

• Direct Observationo Meal preparation in model kitcheno Trained scorers and predetermined scale

• Self-report survey• Data analysis

o Descriptive and frequency statistics (SPSS 15.0)

Tell someone they are doing it wrong• Don’t eat that• Don’t do it that way• Do this instead• It’s really simple• It’s your fault

From Feb 1, 2010• “Educating consumers that their food is not

sterile and cooking accordingly can go a long way to reducing the rate of foodborne illness in this country, according to a speaker at the 2010 Conference on Antimicrobial Resistance.”

• David White, FDA

Another gap example• Consumers appear to highly value information

that allows them to judge the likelihood and severity

• <60% Americans report having ever looked for recalled food in their homes

• Many believe that recalls are relevant to others and not to themselves.

(Hallman, Cuite and Hooker, 2009)

(Hallman, Cuite and Hooker, 2009)

HandwashingPrimary Meal Preparers

Behavior Self-report Direct Observation

Before food preparation 90% 90.5%

After handling raw poultry 90% 52.4%

AdolescentsBehavior Self-report Direct Observation

Before food preparation 90.5% 55%

After handling raw poultry 85% 10%

Read/apply label instructions• Reading: Little time

spent reading

• Applying: Only 7% of all participants followed directions precisely

Participant Group Time Spent (in seconds)

Number of Times

Primary Meal Preparers 22.6 2.9 Adolescents 21.4 3.2

Food Thermometer UsePrimary Meal Preparers

Behavior Self-report Direct Observation

Owns a food thermometer 80.9% ---

Uses a food thermometer while cooking 9.5% ---

Used a food thermometer while cooking raw breaded chicken

19% (4)* 19%

AdolescentsBehavior Self-report Direct

ObservationOwns a food thermometer 68.4% ---

Uses a food thermometer while cooking 0% ---

Used a food thermometer while cooking raw breaded chicken

20% 5%

FSIS issues public health alert for Frozen Chicken and Turkey Pot Pies• 135 Salmonella typhimurium cases in 35

States • Several U.S. state health departments have

told ConAgra Foods Inc. its Banquet pot pies may be linked to cases, but the company says the pies are safe if they're cooked properly

• No recall is being planned

Communication woes• "Consumers should always read the directions to make sure

they are cooking the product properly," Childs said.• Pot pies need to be cooked longer in microwaves that have

less power, Childs said. A good sign that the pot pie is done is when steam rises out of it.

• Childs said the cooking will kill any common pathogens routinely found in uncooked products that contain poultry.

Public perception of risk• voluntary risks are accepted more readily than those

that are imposed• risks under individual control are accepted more

readily than those under government control• risks that seem fair are more acceptable than those

that seem unfair• risk information from trustworthy sources is more

readily believed than information from untrustworthy sources

Public perception of risk (cont’d)

• risks that seem ethically objectionable will seem more risky than those that don’t

• natural risks seem more acceptable than artificial risks

• exotic risks seem more risky than familiar risks

Obstacles to Effective Risk Communication• Lack of information• Conflicting messages & interpretations• Terminology / jargon• Reluctance to change / strongly held beliefs• Limited understanding of target audience• Selective & biased media reporting• Public apathy or outrage

Why Do You Buy Local?• 2007 Phone survey (n=300)• They concluded that residents prefer local

because they believe o it is healthier and tastes better o it contributes to the local economy and protects the

environmento it helps to preserve the rural character of the region

o Appalacian Sustainable Agriculture Project

Local Movement• Maximum freshness,

premium taste, and unique varieties

• Strengthen local economy

• Supporting family farms• Personal relationship

o trust

• Smaller scale• Less travel

o Less fuel usage• Reduces carbon

dioxide emissions• Reduces packing

materials

Who is at most risk?• Carnivore, herbivore, omnivore,

locavore• All at risk for foodborne illness• “Bacteria are blind… They don't see

whether the eggs come from a local farmer or are free-range or organic”o Todd Pritchard, U Vermont. AP, March

2010

Georgia Organics Local Food Guide 2007-8• “Greatest benefit is the relationship that

develops between consumer and farmer• Farm produce is no longer an easily-replaced

commodity; it has personality, a story, and a sense of place. It becomes life-enriching, not just life-sustaining.”

We need to make public discussion of food safety more part of the discussion• What are the

important risks?• How should they be

managed?

Where do the differences lie the most• The conventional supply chain has incentives

(market) for requirements (food safety)• The local, direct market supply chain likely

does not o This may even be the value to some customers

Retail/foodservice

DistributionProduction Consumers

Marketing food safety culture

Customer feedback

S 510 concerns for local food businesses• “Unfortunately, many key GAP protocols lack

scientific basis, and the economic cost of complying with those unfounded mandates are devastating to small and organic farms.

• “In some cases they even contradict organic certification rules.”

Marketing a food safety culture• The goal of the food safety professional

should be to create a food safety culture – not a food safety program.

• Regardless of size, location or marketo Can be done with small producerso Local markets

Local food safety story• The best companies should brag about their

microbial food safety efforts and accomplishments.

• With so many sick people each year, there’s an attentive audience out there.

• A compelling consumer story includes “foods from safe sources” o Really, really important to back it up.

Where do we go• Empower consumers to ask

questions about sourceo What are the right answers?o Are there models we can take from

the large supply chain?• Support from regulatory,

academic/outreach/extensiono and competing industry?

So what does this all mean?• Measuring behavior is important/observation• What people say and do can be very different• Education alone ≠ application of knowledge gained• Risk identification practices vary• Re-evaluate sanitized messages/tailor• Providing easy access to tools does not necessarily

improve desired practices

Food safety communication • Audiences are all different, subgroups within

audiences• Message/medium need to compel• It’s not as much education as it is

communication• Evaluation of efforts is important

Dr. Ben Chapmanbenjamin_chapman@ncsu.eduFollow me on twitter @benjaminchapman919 809 3205www.foodsafetyinfosheets.comwww.barfblog.com