Nancy Sittler Region Of Waterloo Public Health Canadian Institute of Public Health Inspectors Annual Educational Conference June 20-23, 2010 Guelph, ON
Presentation Overview Background Significance Aim of Research Methods Results Conclusions & Recommendations
Background Impact of changing societal trends Food consumption research in Canada Nutrition data Food supply or economic data
Significance Relationship between food consumption patterns & enteric illness unknown outside of outbreak investigations
Aim of research To describe, for the first time, the food consumption patterns in a Canadian-based population from a food safety perspective, in order to establish baseline data on actual food intake and domestic food safety knowledge and practices of individuals.
Methods and survey design Study population Waterloo Region Sentinel site for C-EnterNet Population >450,000
Methods and survey design Cross-sectional telephone survey Multi-stage random sampling design Individuals >18 months of age Individuals who did not travel outside Canada Data collection November 2005 & March 2006 7 day food recall
Methods and survey design Questionnaire 12 Topic Areas Meals and dining location Fruits & vegetables Dairy and eggs Alternative protein sources Meats & seafood Water
Methods and survey design Questionnaire 12 Topic Areas Home hygiene & food safety knowledge Health (occurrence of gastrointestinal illness) Demographics (age, gender, income, education, ethnicity, place of residence, pet ownership, number of children in household and household size) Grocery shopping practices and retail meat Convenience foods Food preparation & handling practices
Results: Study population characteristics Complete interviews n=2,332 Response rate 32.7% Demographic profile: Older than census population - Median age: survey 40.0 yrs; Census 35.3 yrs >Female Higher education level Higher total annual household income Less likely to have an urban residence
Results: Consumption of high-risk food items Dairy products & eggs: Unpasteurized milk 0.7% More prevalent among rural residents (9.0%) than urban residents (0.4%) Cheese made from unpasteurized milk 1.1% Ate egg dishes with runny yolk 42.3% Increased with increasing age (individuals >64 yrs 49.7%) Ate food items containing raw egg 5.9% (i.e. cookie dough, cake batter, steak tartar)
Results: Consumption of high risk food items Vegetables & fruits: Lettuce 84.8% Pre-bagged mixed salad greens 39.6% Sprouts (i.e. mung bean, alfalfa) 11.0% Less prevalent among children <12yrs & individuals >64 yrs Unpasteurized juice 6.1%
Results: Consumption of high risk food items Meat & seafood: Raw fish (i.e. sushi) 7.9% Raw shellfish (i.e. oysters, clams, muscles, scallops) 5.6% Chicken nuggets/strips 19.2% Decreased with increasing age (children <12 years 59.9%)
Results: Food safety knowledge & practice Food safety knowledge Self rating of knowledge about safe food handling compared to the average person Excellent 16.9% Very good 34.5% Good 29.0% Fair 14.4% Poor 5.1% Source of food safety knowledge Family / friends 75.1% Television / news 18.6% School / home economics 15.1% Public health / primary health care 1.2%
Results: Food safety knowledge & practice Food safety knowledge Heard of risks associated with the following foods Chicken 83.8% Hamburger 83.5% Unpasteurized milk 52.1% Alfalfa sprouts 34.2% Raw oysters 33.6% Unpasteurized apple juice 29.5% Source of information on foods to avoid eating Electronic media (television, news, Internet) 30.2% Family / friends 9.1% Public health 1.5%
Results: Food safety knowledge & practice Hand Washing Practices Do not always wash hands before handling or eating food 32.7% Importance of hand washing in the prevention of disease 96.9% Main reason for washing hands before handling or eating food Remove bacteria/kill germs 75.8% Hygiene/cleanliness 28.5% Habit/told to 8.2% Cooking 3.3% Profession 1.4% Children in household 1.1% Pet in household 0.6%
Results: Food safety knowledge & practice Cooking practices Noticed safe cooking/handling label of meat package 49.8% How do you know when meat is cooked enough to eat? Visually 63.9% Time 32.8% Thermometer 13.7% Taste 9.7%
Results: Food safety knowledge & practice Refrigerator temperatures Correct recommended refrigerator temperature 0-5 C 34.8% 6-10 C 3.2% 11-15 C 1.3% 16-20 C 0.3% >20 C 0.6% Don t know 59.8% Knew temperature inside own refrigerator 17.4% Set refrigerator temperature >6 C 6.8%
Results: Food safety knowledge & practice & demographic variables Gender Males more likely to consume high-risk foods, and engage in unsafe food consumption and preparation practices than females Income Household with lowest income level (<$20,000) were less likely to engage in risky eating behaviours and unsafe food practices than higher income households Education Unsafe food practices were variable Knowledge of foods as risk factors for foodborne illness increased as education level increased
Results: Food safety knowledge & practice & demographic variables Age Unsafe food practices were variable Specific high-risk behaviours of public health concern Knowledge of foods as risk factors for foodborne illness increased with increasing age Individuals >64 years knowledge decreased Residence Unsafe food handling practices and consumption of high-risk foods were variable. Both knowledge of disease risks associated with unpasteurized milk and consumption was most prevalent in rural residents
Conclusions Identified specific unsafe food consumption & handling behaviours that might put consumers at risk for illness Respondents appear to know proper food safety practice but do not put them into practice Food safety practices may be important risk factors of gastroenteritis
Health Communication Strategies Target audience? Appropriate messaging Methods of conveying risk
Social Marketing Principles of social marketing Social marketing has been successful in influencing the target audience to: Accept new desirable behaviour Reject potentially undesirable behaviour Modify current neutral behaviour Abandon existing bad behaviour (Kotler & Lee, 2008)
Social Marketing Health communication will encourage the target audience to: Accept that handwashing practice prior to food preparation reduces illness Reject taking on unnecessary risks Modify consumption of leafy greens Abandon visually assessing whether meat appears cooked
Recommendations Consumer food safety educational efforts Directed to targeted audiences Emphasize practices identified in this study Communication of food safety messages Electronic media Further investigation regarding consumer perceptions / barriers in implementing practices
Acknowledgments & Partnerships