EAL

MHFS: Food Safety (2012-2013)

Citation:

Study Design:

Class:

- Click here for explanation of classification scheme.

Quality Rating:

Research Purpose:

To determine if the following conditions were associated with greater risky eating behaviors in young adults:

Number of nutrition, microbiology and food science courses completed in college
Previous foodservice experience and food safety certification
Previous food poisoning
Being male
Lower food safety knowledge
Lower stage of change and self-efficacy.

Inclusion Criteria:

Students in general education courses (ie, introductory psychology, biology or nutrition)
Aged 17 to 26 years.

Exclusion Criteria:

Students younger than 17 years or older than 26 years.

Description of Study Protocol:

Recruitment

College or university instructors across the United States invited via e-mail to recruit students in their introductory courses to complete online food safety survey
Invitations sent to:
- Department chairs with programs approved by the American Psychological Association or American Dietetic Association
- Deans at all universities with a college or school of Human Ecology
- Professors who subscribed to a psychology, biology or nutrition electronic mailing list.

Design

Cross-sectional survey to assess self-reported risky eating behaviors of young adults enrolled in higher education. Survey included items to assess self-reported food preparation, safe food handling self-efficacy, food poisoning beliefs and readiness to make food safety changes. Food safety knowledge was assessed using an 89-item knowledge questionnaire.

Statistical Analysis

Descriptive statistics to describe study participants and risky eating scores
Spearman's ρ for correlations between risky eating scores, self-efficacy and stage-of-change measures
ANOVA to test for linear trends with stage of change scores (integers one to five)
Backward stepwise regression to identify demographic characteristics and scores associated with risky eating behavior.

Data Collection Summary:

Timing of Measurements

Survey administered over 10 months.

Dependent Variables

Responses to a survey covering a randomly ordered list of 26 food items; 20 were considered risky, six were considered safe to eat and seven items addressed how completely cooked participants chose to eat animal proteins (eg, raw to well done). One point was awarded for each risky eating behavior and summed (range zero to 27).
Responses to a safe food handling self-efficacy scale that was assessed using a five-point Likert type scale; 24 items regarding confidence in ability to perform safe food handling behaviors (Cronbach α 0.91). Higher scores denote higher self-efficacy.
Responses to a food-poisoning belief scale that included six five-point Likert type items (Cronbach α 0.87)
Responses to a food safety stage of change scale that was modeled after the Transtheoretical Model
Responses to a food safety knowledge questionnaire that included nine items (score range zero to 89).

Independent Variables

Young adults enrolled in higher education:

Age
Sex
Race.

Description of Actual Data Sample:

Initial N: 4,548 students completed the survey between January and October 2005 from a total of 21 colleges or universities from 17 states
Attrition (final N): 4,343 young adults included in the analysis
Age: Mean 19.92 ±1.67 years
Ethnicity:
- White: 70%
- Nonwhite: 30%
Other relevant demographics:
- Female: 65%
- Freshmen or sophomores: 79%
- Prepared at least one meal per week: 84%
- Perceived themselves to be in excellent/good health: 88%
- Reported no food poisoning in past year: 80%
- Never held a job serving food: 60%
- Never prepared food: 76%
- Did not hold a food safety certification: 94%
- Never completed a college nutrition course: 77%;
- Never completed a food science course: 88%
- Never completed a microbiology course: 84%
Location: Survey researchers from Rutgers in New Jersey. Survey responses from across the nation; geographic dispersion not mentioned.

Summary of Results:

Key Findings:

Self-reported Food Safety Measures

Measures^a	Total Group (N=4,343) Mean±STD	Male (N=1,502) Mean±STD	Female (N=2,841) Mean±STD	White (N=3,059) Mean±STD	Nonwhite (N=1,284) Mean±STD
Risky food consumption (range zero to 27)	5.1±3.6	5.9±4.3	4.7±3.1*	5.3±3.6	4.8±3.6*
Food safety self- efficacy (range one to five)	4.1±0.6	3.9±0.6	4.2±0.5*	4.2±0.5	4.1±0.6*
Stage of change (range one to five)	2.7±1.2	2.4±1.2	2.8±1.2*	2.7±1.2	2.6±0.5
Food poisoning is personal threat (range one to five)	3.1±0.8	2.9±0.8	3.2±0.8*	3.0±0.8	3.4±0.8*
Food safety knowledge (range zero to 89)	53.7±10.5	51.3±11.3	55.0±9.7*	55.6±9.9	49.1±10.4*

^a Note: Higher values indicate more of the behavior.

* P<0.001 for differences within categories (eg, sex, race).

Other Findings

Mean risky eating score (5.1±3.6) indicated that young adults consumed risky foods
Male respondents and whites consumed more risky foods compared with female respondents and nonwhites, respectively
53% consumed home-made raw cookie dough, 33% fried eggs with runny yolks, 29% sushi, 29% sprouts, 11% raw oysters, 7% rare burgers
Correlation between food safety knowledge and risky eating score weak (P=-0.031, P=0.03)
No differences in risky eating behavior scores between those taking a college course (previously mentioned) vs. not taking a course
Strongest predictor of risky eating score was self efficacy followed by stage of change; those who believed food poisoning was a personal threat tended to eat fewer risky foods. Along with sex and race, this accounted for 10% of the variance.

Author Conclusion:

Young adults, particularly white men, engage in risky eating behaviors. Current safe food-handling practices, food safety self-efficacy and stage-of-change all help explain risk for engaging in risky eating practices. Although food safety knowledge correlated weakly with risky eating score, it did not significantly predict it. The high self-efficacy and belief that food poisoning is a personal risk suggests this population is willing to take the issue of food safety seriously; however, being between the contemplation and preparation stage of change and having modest food safety knowledge highlights a need for more food safety education.

Funding Source:

Government:

US Department of Agriculture, National Food Safety Initiative

Reviewer Comments:

The response from a small sampling of colleges across the United States limits the generalizability to all young adults
Question the validity of some of the scales used (eg, stage-of-change)
Mean risky food consumption score on the low end of the scale.

Quality Criteria Checklist: Primary Research
Relevance Questions
	1.	Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)	N/A
	2.	Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?	Yes
	3.	Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?	Yes
	4.	Is the intervention or procedure feasible? (NA for some epidemiological studies)	N/A

Validity Questions
1.	Was the research question clearly stated?		Yes
	1.1.	Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?	Yes
	1.2.	Was (were) the outcome(s) [dependent variable(s)] clearly indicated?	Yes
	1.3.	Were the target population and setting specified?	Yes
2.	Was the selection of study subjects/patients free from bias?		Yes
	2.1.	Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?	Yes
	2.2.	Were criteria applied equally to all study groups?	Yes
	2.3.	Were health, demographics, and other characteristics of subjects described?	Yes
	2.4.	Were the subjects/patients a representative sample of the relevant population?	???
3.	Were study groups comparable?		Yes
	3.1.	Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)	Yes
	3.2.	Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?	Yes
	3.3.	Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)	N/A
	3.4.	If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?	Yes
	3.5.	If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)	N/A
	3.6.	If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?	N/A
4.	Was method of handling withdrawals described?		No
	4.1.	Were follow-up methods described and the same for all groups?	Yes
	4.2.	Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)	No
	4.3.	Were all enrolled subjects/patients (in the original sample) accounted for?	Yes
	4.4.	Were reasons for withdrawals similar across groups?	No
	4.5.	If diagnostic test, was decision to perform reference test not dependent on results of test under study?	N/A
5.	Was blinding used to prevent introduction of bias?		N/A
	5.1.	In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?	N/A
	5.2.	Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)	N/A
	5.3.	In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?	N/A
	5.4.	In case control study, was case definition explicit and case ascertainment not influenced by exposure status?	N/A
	5.5.	In diagnostic study, were test results blinded to patient history and other test results?	N/A
6.	Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?		Yes
	6.1.	In RCT or other intervention trial, were protocols described for all regimens studied?	N/A
	6.2.	In observational study, were interventions, study settings, and clinicians/provider described?	Yes
	6.3.	Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?	N/A
	6.4.	Was the amount of exposure and, if relevant, subject/patient compliance measured?	N/A
	6.5.	Were co-interventions (e.g., ancillary treatments, other therapies) described?	N/A
	6.6.	Were extra or unplanned treatments described?	N/A
	6.7.	Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?	N/A
	6.8.	In diagnostic study, were details of test administration and replication sufficient?	N/A
7.	Were outcomes clearly defined and the measurements valid and reliable?		Yes
	7.1.	Were primary and secondary endpoints described and relevant to the question?	Yes
	7.2.	Were nutrition measures appropriate to question and outcomes of concern?	Yes
	7.3.	Was the period of follow-up long enough for important outcome(s) to occur?	Yes
	7.4.	Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?	???
	7.5.	Was the measurement of effect at an appropriate level of precision?	N/A
	7.6.	Were other factors accounted for (measured) that could affect outcomes?	Yes
	7.7.	Were the measurements conducted consistently across groups?	Yes
8.	Was the statistical analysis appropriate for the study design and type of outcome indicators?		Yes
	8.1.	Were statistical analyses adequately described and the results reported appropriately?	Yes
	8.2.	Were correct statistical tests used and assumptions of test not violated?	Yes
	8.3.	Were statistics reported with levels of significance and/or confidence intervals?	Yes
	8.4.	Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?	N/A
	8.5.	Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?	N/A
	8.6.	Was clinical significance as well as statistical significance reported?	Yes
	8.7.	If negative findings, was a power calculation reported to address type 2 error?	N/A
9.	Are conclusions supported by results with biases and limitations taken into consideration?		Yes
	9.1.	Is there a discussion of findings?	Yes
	9.2.	Are biases and study limitations identified and discussed?	Yes
10.	Is bias due to study's funding or sponsorship unlikely?		Yes
	10.1.	Were sources of funding and investigators' affiliations described?	Yes
	10.2.	Was the study free from apparent conflict of interest?	Yes