A systematic review and meta-analysis of the effectiveness of food safety education interventions for consumers in developed countries

Assessment of Food Safety Knowledge and Practices Among Medical Students

Food safety is an important requirement for protecting human health worldwide. In particular, medical students' education on food safety is essential for them as future physicians, and university education is the first step in acquiring this knowledge. We performed an online survey with 1277 respondents among medical students to assess knowledge, attitudes, and practices (KAPs) related to food safety regarding microbiological contamination. Our findings showed that more than half of the respondents presented a low level of food safety knowledge, with a score between 11-60 points, and only 6% managed to score between 81 and 100 points, which was considered a high level of knowledge. On the contrary, we found that most participants had a high level of good practice: 58% scored more than 25 points, 39% had an average level of good practice (scoring between 21 and 25 points), and 3% of respondents had a low level of good practice (scoring below 21 points). We also noticed a statistically significant difference between total scores of preclinical and clinical years of study among medical students (p = 0.005) regarding food safety knowledge. The frequency of cooking was positively correlated with the level of food safety knowledge, but not with food safety practices. Our study shows that better knowledge on food safety is needed among medical students. Improving knowledge and awareness of food safety in relation to microbiological contamination is a good way to protect themselves and to promote the correct food safety knowledge and measures among their patients.

Predictive Models of Consumer Flour-Handling Behaviors and Recall Awareness

In recent years, many recalls have been linked to flour and flour-based products. However, many consumers remain unaware of these recalls and continue to perform risky flour-handling behaviors. Food recalls are an essential tool for manufacturers, distributors, and government agencies to inform consumers about foods that may cause health issues, which has the potential to change consumers' food safety behaviors. In this study, researchers constructed model-ensembles to predict and identify the top predicting factors for consumers' flour recall awareness and their safe flour-handling behaviors. Researchers also tested the impact of the volume of flour recalls within a consumer's state of residence on their recall awareness and flour-handling behaviors. Findings indicate that consumers who perceive a higher likelihood of flour recall, aged between 18 and 24, and who pay attention to the lot number, are more likely to be aware of flour recalls. Consumers who perceive the risks of eating raw dough or batter, believe raw chicken poses a microbial risk, and are younger, are more likely to have an increased flour-handling behavior score. However, the volume of recalls in a consumer's state of residence was found to have a low predictive ability for consumers' flour recall awareness and safe flour-handling behaviors. This is the first study utilizing predictive modeling to investigate the critical factors affecting consumers' flour recall awareness and handling behaviors. The findings emphasize the importance of risk perceptions in shaping consumers' behaviors and provide implications for policymakers, food safety experts, and educators in tailoring communication strategies to enhance consumers' risk perceptions and thereby reduce their likelihood of contracting foodborne illnesses due to improper flour-handling behaviors.

Communication Intervention to Improve Young Adults' Food Safety Practices: The Benefits of Using Congruent Framing

Background/Objectives: Improving food safety practices among young adults is critical to public health, but effective communication strategies are under-researched. This study investigated the effectiveness of a 12-day message-based intervention to promote safe food handling practices using a randomised controlled trial. Methods: A total of 588 participants (aged 18 to 35 years) were randomly assigned to one of four experimental conditions or to a control group. Participants in the intervention groups received daily messages via a mobile app, while the control group received no messages. The intervention combined belief-based content to raise awareness with skill-based content to teach practical food handling, framed by either positive or negative emotional appeals. The experimental conditions differed in message congruence, with belief-based and skill-based content framed either consistently (both positive or both negative) or inconsistently (one positive, one negative). To assess the impact of the intervention, self-reported adherence to food safety practices, food safety awareness, and self-efficacy were measured at baseline and post-intervention. Results: The results showed that the intervention significantly improved food safety practices, especially when the messages were congruent in valence. Pre-intervention self-efficacy moderated the effects, with higher self-efficacy increasing receptivity to certain messages, while lower self-efficacy benefited from a different framing. Self-efficacy, but not awareness, mediated behaviour change, highlighting its key role in the success of the intervention. Conclusions: These results emphasise the importance of message valence congruence and individual self-efficacy levels in designing effective food safety interventions. Future research should investigate long-term intervention effects, adaptive mHealth strategies, and tailored communication approaches to maximise engagement and sustained behaviour change.

Random forest models of food safety behavior during the COVID-19 pandemic

Machine learning approaches are increasingly being adopted as data analysis tools in scientific behavioral predictions. This paper utilizes a machine learning approach, Random Forest Model, to determine the top prediction variables of food safety behavioral changes during the pandemic. Data was collected among U.S. consumers on risk perception of COVID-19 and foodborne illness (FBI), food safety practice behaviors and demographics through online surveys at ten different time points from April 2020 through to May 2021; and post pandemic in May 2022. Random forest model was used to predict 14 food safety-related behaviors. The models for predicting Handwashing before cooking and Handwashing after eating had a good performance, with F-1 score of 0.93 and 0.88, respectively. Attitudes- related variables were determined to be important in predicting food safety behaviors. The importance ranking of the predicting variables were found to be changing over time.

Empowering consumers to purchase safe ready-to-eat chicken from street restaurants in Ouagadougou, Burkina Faso: impact of a multi-media behavior change campaign

Foodborne disease resulting from food sold at urban informal markets is a major public health challenge in Sub-Saharan Africa. This study assessed the impact of an innovative nine-months multi-media campaign engaging a key influencer, aimed at empowering consumers to choose safer ready-to-eat chicken meat at informal street restaurants in Ouagadougou, Burkina Faso. A two-wave panel study assessed associations between recall of TV, radio, billboard, and social media advertisements, and self-reported behavior regarding purchasing and consumption of ready-to-eat chicken at outlets, consumer intentions, knowledge, attitudes, norms, and agency. A panel of randomly selected adult consumers (n = 852) were interviewed pre- and post-campaign, 12 months apart. 60% recalled at least one of the campaign channels when prompted. Mixed-effects models showed associations between prompted recall and feeling better informed about food safety (aOR 1.449) and increased knowledge (0.132 unit increase on total score). Social media recall was associated with higher perceived access to information (aOR 1.449) and knowledge. Billboard recall increased odds of higher perceived health benefits of paying attention to food safety behaviors when purchasing chicken (aOR 2.046). TV ad recall was associated with a 0.159 unit decrease in the gap between consumers' intentions and behavior. An engaging consumer food safety multimedia campaign that engages key influencers improved food safety awareness and knowledge, ultimately supporting consumers to choose safer chicken at markets.

Effects of health educational and participatory consumer group interventions in improving food handling practices in regional director of health services area Kalutara, Sri Lanka: non-randomized controlled community trial

INTRODUCTION

Safe and nutritious food is the key to sustaining life and promoting good health. Unsafe food creates a vicious cycle of disease and malnutrition, particularly affecting infants, young children, the elderly, and the sick.

METHODS

The study consisted of two phases, a descriptive cross-sectional study, and an intervention study. Both studies were conducted in the Regional Director of Health Services area, Kalutara, Sri Lanka. The descriptive cross-sectional study [food handlers (n = 904), food establishments (n = 421)] was conducted with the objective of determining factors associated with food handling practices among food handlers and in food establishments. The interventional study was a three-arm non-randomized controlled community trial (n = 50 per arm) with interventions of a participatory consumer group, educational package group, and control group.

RESULTS

The food establishments assessment tool (FEAT) contained 11 domains including 75 items with more than a hundred assessment points with a guide to conduct an assessment of food handling. The descriptive cross-sectional study found that food handlers' knowledge of food handling practices of storing milk, fish, and meat and fast-food items containing fish and meat was very poor (96.6%). Visibility of the last place of processing inside the food establishments to consumers was inadequate (19.2%) and the absence of the above-mentioned factor was significantly associated with an unsatisfactory level of food handling score in food establishments (p = 0.03). The unsatisfactory level of food handling was significantly higher among food establishments with non-personal ownership (p = 0.005), a low number of notices issued by legal authorities (p = 0.02), dereliction of duty by owners/managers on supervising (p < 0.001) and lack of medical certification to food handlers (p < 0.0001). Participatory consumer group intervention and educational package interventions were effective in improving food handling practices in food establishments and among food handlers (p < 0.0001). Two independent sample analysis using the Mann-Whitney U test showed, the best improvement in food handling practices was by participatory consumer group intervention (p < 0.0001) and the second was educational package intervention (p < 0.0001).

CONCLUSIONS

Knowledge and practices of food handling among participants were poor. A participatory consumer group is more effective than an educational package on improving food handling practices both among food handlers and in food establishments.

Effectiveness of Online Food-Safety Educational Programs: A Systematic Review, Random-Effects Meta-Analysis, and Thematic Synthesis

Online food-safety educational programs are increasingly important to educate different populations as technology and culture shift to using more technology. However, the broad effectiveness of these programs has yet to be examined. A systematic review, random-effects meta-analysis, and thematic synthesis are conducted to identify the effect size of online food-safety educational programs on knowledge, attitudes, and practices of consumers, food workers, and students and their respective barriers and recommendations. Online food-safety education was found to be of moderate and low effectiveness, with attitudes being the lowest in all populations. Consumers struggled with staying focused, and it was found that messaging should focus on risk communication. Students struggled with social isolation and a lack of time, and it was recommended that videos be used. Food workers struggled with a lack of time for training and difficulty understanding the material, and future programs are recommended to implement shorter but more frequent trainings with simple language. Future online food-safety educational programs should focus on incorporating social elements, as they can remain a huge barrier to learning. They should also focus on changing the participant's attitude to risk perception and beliefs in the importance of food safety.

Development of educational package and participatory consumer groups to improve food handling practices in food establishments in Sri Lanka

Objectives

Improper food handling contributes to many foodborne diseases and food outbreaks globally leading to witnessed morbidities and mortalities. The study aims to develop an educational package and participatory consumer groups to improve food handling practices among food handlers and in food establishments in the Regional Director of Health Services area, Kalutara, Sri Lanka.

Methods

The study developed an educational package and participatory consumer groups to improve the food handling practices among food handlers and in food establishments. The critical knowledge gaps were identified during the first component of this study, which was conducted as a descriptive study, and the findings were further discussed in the Focus Group Discussion. Posters, info sheets, and workshops were used for educational packages, and four consumer groups were formed. The second component of the study following the development of the interventions was continued as a three-arm, non-randomized controlled community trial for 4 months in the Regional Director of Health Services, Kalutara.

Results

The educational package for food handlers was introduced as a package of a workshop, info sheets, posters to display at workplaces, and short refresher training two weekly to direct good food handling practices in food establishments. Consumer groups were strengthened to exercise their legal rights on their purchases and the ratings showed improvements in the hygiene levels with repeated consecutive visits.

Conclusions

The novel educational package and participatory consumer groups are designed and implemented to improve food handling practices among food handlers and in food establishments.

Effect of WeChat-based intervention on food safety knowledge, attitudes and practices among university students in Chongqing, China: a quasi-experimental study

BACKGROUND

Food safety is of global importance and has been of concern in university settings in recent years. However, effective methods to conduct food safety education are limited. This study aims to evaluate the effects of an intervention on food safety knowledge, attitudes and practices (KAP) by social media, WeChat, among university students.

METHODS

A quasi-experimental study was conducted in Chongqing, China. Two departments were recruited randomly from a normal university and a medical university. One department from each university was randomly selected as the intervention group and the other as the control group. All freshmen students in each selected department were chosen to participate in this study. One thousand and twenty-three students were included at baseline, and 444 students completed the study. This intervention was conducted through food safety-related popular science articles with an average of three articles per week released by WeChat official accounts called "Yingyangren" for two months to the intervention group. No intervention was conducted in the control group. An independent t-test was used to test statistical differences in the food safety KAP scores between the two groups. A paired t-test was used to test statistical differences in the food safety KAP scores between before and after the intervention. And quantile regression analysis was conducted to explore the difference between the two groups across the quantile levels of KAP change.

RESULTS

After the intervention, compared with control group, participants in the intervention group did not score significant higher on knowledge (p = 0.98), attitude (p = 0.13), and practice (p = 0.21). And the scores of food safety knowledge and practices slightly improved after the intervention both in the intervention group (p = 0.01 and p = 0.01, respectively) and in the control group (p = 0.0003 and p = 0.0001, respectively). Additionally, the quantile regression analysis showed that the intervention had no effect on improving the food safety KAP scores.

CONCLUSIONS

The intervention using the WeChat official account had limited effects on improving the food safety KAP among the university students. This study was an exploration of food safety intervention using the WeChat official account; valuable experience can be provided for social media intervention in future study.

TRIAL REGISTRATION

ChiCTR-OCH-14004861.

Validity and Reliability of a Questionnaire on the Knowledge, Attitudes, Perceptions and Practices toward Food Poisoning among Malaysian Secondary School Students: A Pilot Study

Children in school settings are at risk of contracting food poisoning due to inadequate food safety practices and safe eating behaviors. This research aimed to develop a valid and reliable questionnaire on the knowledge, attitudes, perceptions, and practices (KAP2) toward food poisoning and its prevention among secondary school students. The questionnaire was developed by considering the Health Belief Model (HBM). A pilot study using a cross-sectional survey was conducted in Tangkak, Johor, among 30 selected students using a convenience sampling method. A pre-test was conducted on 15 secondary school students aged 13–17 years old prior to the pilot study, and they were excluded from the pilot study. The constructed knowledge was assessed using the difficulty and discrimination indices. Meanwhile, the reliability of the attitude, practice, and perception components in the questionnaire were assessed using Cronbach’s alpha. Regarding knowledge (34 items), the difficulty index showed that most items (n = 28) were easy, while one was difficult, and the remaining five were within an acceptable range. In addition, the discrimination index of the knowledge component (34 items) showed that twenty-two, three, and one had good, acceptable, and excellent ranges, respectively. Only eight items had a low discrimination power. All items of the attitude and practice components (10 items for each) showed a corrected item-total correlation value of >0.30. Only four out of twenty-one items of the perception component showed an unacceptable range of <0.30. However, following a discussion with the experts, all items were retained. With the incorporation of the HBM, the 75-item adapted food poisoning KAP2 questionnaire is valid and reliable. It can be utilized to measure and generate food poisoning KAP2 among secondary school students in Malaysia.

Food safety knowledge and practices among food handlers and consumers in Gulf countries: An integrative review

Foodborne illnesses result from inadequate food handling practices, but prevention is possible through implementing food safety principles by handlers and consumers. This paper presents an overview of food safety knowledge and practices among food handlers and consumers in the Gulf countries, identifies factors affecting knowledge and practice, and offers recommendations for promoting food safety among handlers and consumers. A literature search was conducted using an integrative review method. Various combinations of the following descriptors were used: (food safety, food hygiene), (knowledge, practice), and (Saudi Arabia, Qatar, UAE, Bahrain, Oman, and Kuwait). Out of 164 studies screened, 37 met the eligibility criteria. Food handler studies reported insufficient food safety knowledge, with poor translation of existing knowledge into practice. Consumer studies showed varying levels of food safety knowledge, and the translation of existing knowledge into practice was also found to be inconsistent. Training and educational level were the primary factors positively affecting food safety knowledge and practices. Overall, significant gaps in knowledge and practices were identified among food handlers and consumers in the Gulf. These gaps require urgent attention from the Gulf regulatory bodies to develop targeted food safety training and education programs to enhance awareness and implementation of food safety principles.

Foodborne zoonoses control in low- and middle-income countries: Identifying aspects of interventions relevant to traditional markets which act as hurdles when mitigating disease transmission

Globally, foodborne zoonoses are responsible for approximately one third of all foodborne disease burden and this picture is likely to worsen if consumption of animal source foods continues to rise with insufficient attention to risk mitigation. Traditional markets represent highly important nodes that can be targeted for risk mitigation; in this series of case studies, we discuss food safety interventions relevant to this nexus. We illustrate that to improve food safety within traditional markets it is essential to consider some of the motivations and incentives of the stakeholders involved and the cultural, social, and economic context in which interventions are undertaken, highlighting barriers, enablers future interventions should aim to avoid, embrace. We also conclude that a holistic approach to foodborne zoonoses control will require the institutionalization of One Health across food systems of which traditional markets are part.

Chromium Supplementation on the Growth Performance, Carcass Traits, Blood Constituents, and Immune Competence of Broiler Chickens Under Heat Stress: a Systematic Review and Dose-Response Meta-analysis

Several studies have been conducted to assess the effects of supplemental dietary chromium (Cr) on broiler chickens under heat stress (HS) conditions, but the shape and strength of the associations between Cr supplementation and broiler chickens' responses to HS remain unclear. Therefore, the current systematic review and meta-analysis investigated the effectiveness and dose-response relationship of Cr. The results indicated non-linear dose-response associations between Cr supplementation and body mass gain (BMG), feed intake (FI), feed conversion ratio (FCR), carcass, breast, leg, and abdominal fat relative weight (P_{non-linearity} < 0.05). The maximum BMG, FI, and the relative weight of carcass, breast, and leg would be achieved with 1200, 1100, 900, 800, and 800 ppb of Cr, respectively, while the lowest FCR and abdominal fat relative weight might be obtained with the supplementation of 1100 and 1000 ppb of Cr, compared with no Cr supplementation. Referring to BMG, supplementation with 1200-1700 ppb inorganic Cr or 2700 ppb or less organic Cr had a significant beneficial effect on the BMG, while NanoCr supplementation did not influence this outcome variable. A non-linear association was observed for blood total cholesterol concentration (TC, P_{non-linearity} < 0.05), with the maximum reduction of TC concentration observed at approximately 900 ppb of Cr. The cholesterol-lowering effect of Cr (≤ 2400 ppb) was only found in severe HS conditions. Moreover, supplemental Cr caused a significant linear reduction in the blood triglycerides and glucose concentrations (P < 0.05). The blood concentrations of triiodothyronine, thyroxine, and insulin increased linearly, and the corticosterone concentration reduced, with increasing supplemental Cr (P < 0.05). There was a non-linear inverse association between Cr supplementation and cortisol level (P_{non-linearity} < 0.05), and the lowest concentration of cortisol was observed with the supplementation of 1000 ppb of Cr. Meanwhile, significant positive linear associations between Cr supplementation and bursa percentage, thymus percentage, infectious bronchitis vaccine titer, avian influenza vaccine titer, Newcastle disease vaccine titer, cutaneous basophil hypersensitivity response, and serum immunoglobulin G level were found (P < 0.05). However, Cr supplementation caused a linear reduction in the heterophil/lymphocyte ratio (P < 0.05). Based on the obtained results, the recommended optimum amount of supplemental Cr is 1100 ppb.

Assessing Existing Food Safety Resources with United Kingdom-Based Chemotherapy Patients and Family Caregivers for Future Learning Purposes

ABSTRACT

Because the incidence of foodborne infection is more prevalent among cancer patients and the domestic kitchen is a contributor to foodborne infection, appropriate domestic food safety practices are needed to safeguard this at-risk population. Although patients are aware of the increased risk of infection, previous self-reported data indicate potential food safety malpractices among patients and family caregivers, thus suggesting the need for targeted food safety information. However, existing United Kingdom resources provide inconsistent and insufficient food safety information. Involvement of intended end users in the cocreation of interventions increases potential effectiveness. Qualitative data were collated from in-depth interviews and a focus group with United Kingdom chemotherapy patients and family caregivers (n = 35) to determine perceptions and preferences for food safety information by evaluating existing food safety resources from international providers (n = 12). Although participants liked digital interventions (e.g., Web sites and videos), traditional paper-based leaflets were perceived as the most beneficial because they could be referred to on repeated occasions. Despite the drawbacks associated with some resources, combining approaches in a multiresource intervention was favored by patients and family caregivers. Ensuring patients are not overwhelmed with excessive information was important. Short, logical, engaging, educational, and entertaining information to evoke an interest in the topic was preferred. Utilization of graphics to supplement descriptive information may enhance comprehensibility. Interventions need to be appropriate for patients and caregivers, and delivery by trusted health care professionals may enhance the credibility of the message. Preferred approaches to facilitate targeted food safety communication were identified, and these findings can be utilized to cocreate targeted food safety interventions for chemotherapy patients and family caregivers.

HIGHLIGHTS

Unpacking the Theory Behind One Health Food Safety Programs: A Vietnam Case Study

Many One Health programs are inherently complex, characterized by multiple perspectives from multiple sectors, delivery across various scales, and a focus on complex problems at the convergence of people, animals, and the environment. This complexity makes them difficult to conceptualize, requiring frameworks to organize the different program components. Evaluation frameworks that unpack the sequence of events linking program activities to outcomes (e.g., Theory of Change) and track outcomes (e.g., Outcome Mapping) show promise in supporting the development of One Health programs. While widely used in international development and health contexts, there has been little reflection on the use of Theory of Change and Outcome Mapping within One Health efforts. This paper reflects on the process of applying these frameworks to conceptualize a One Health food safety program in Vietnam. We find Theory of Change fostered the characterization of a change pathway toward safer pork, while Outcome Mapping kept us informed of where along the change pathway we were. One Health programs considering evaluation frameworks should adopt elements that make sense to them, be intentional about co-designing the evaluation, and view evaluation as a process, not a product.

A quasi-experimental study on the effect of health and food safety training intervention on restaurant food handlers during the COVID-19 pandemic

The restaurant business has turned into a dynamic and ever‐growing industry. So, food safety must be a priority for these establishments, especially during the COVID‐19 pandemic. The aim of this study was to determine the effect of training intervention on the health and food safety knowledge, attitude, and self‐reported practice (KAP) of restaurant food handlers during the COVID‐19 pandemic. This quasi‐experimental study was conducted on 159 restaurant food handlers in Tehran, Iran. The training intervention was developed based on the latest global guidelines. The KAP of the subjects was measured before and after the training. Fisher's exact test, paired t test, and repeated measures ANOVA were used for statistical analysis. Data analysis was done using the IBM_SPSS software. The total knowledge scores of participants were low (17.6%), moderate (35.2%), and good (47.2%) before training, which were changed to 5% (low), 23.9% (moderate), and 71.1% (good) after training. The total pretraining attitude scores were 0.6, 77.4, 18.2, and 3.8% that were changed to 0% (strongly negative), 49.1% (negative), 33.3% (positive), and 17.6% (strongly positive), respectively. Also, the self‐reported practice scores of the participants before training were 1.3, 56, and 42.7 that were changed to 0% (weak), 26.4% (acceptable), and 73.6% (desirable) after the intervention, respectively. Paired t test results showed a statistically significant increase in all scores. The interaction of training with age and education was statistically significant in increasing the knowledge and attitude scores of the participants by the repeated measures ANOVA. Improving the KAP of food handlers by health and food safety training can improve the status of restaurants and minimize the outbreak of pandemic diseases, including COVID‐19, which is an effective step in community health. Thus, it is an urgent need for policymakers to design an online system of continuous food safety training for food handlers.

A bibliometric analysis of food safety governance research from 1999 to 2019

Although the number of food governance-related studies increased rapidly in the recent decade, the current academic research still lacked systematic integration of food safety governance. To clarify the development trends of research therein, this study summarized research articles concerning food safety governance by the Web of Science Core Collection. An in-depth bibliometric analysis was then conducted through CiteSpace to summarize the current characters and hot spots of food safety governance research, and predicted future research trends. Results showed that food safety governance was multidisciplinary, which included environmental science, food science, economics, and agriculture. The United States had the largest number of relevant articles, and Wageningen University was the most influential scientific research institution. Among all the journals in this field, Food Policy ranked the first in publication volume and co-citation frequency. The development of food safety governance research was divided into three processes, namely the separate formulation of the standards for public and private sectors, the joint implementation of these standards, and co-governance by multiple sectors. The most popular research hot spots in this field were food safety policy integration and public-private partnership of food safety governance. Lower- and middle-income countries focused more on food supply and food system design, and regrettably not on food safety. Higher-income countries cared more about food safety and food nutrition. Besides, researchers of higher-income countries also concentrated on consumers' voices in participating in food safety governance. Food safety co-governance, online food governance, the willingness to buy safe food, and food safety governance under pandemics were considered as future research directions.

Moving Forward to the Future: A Review of Microbial Food Safety Education in China

Millions of foodborne illness cases occur in China annually, causing significant social and economic burdens. Improper food handling has been observed not only among commercial food handlers but also among residential food handlers. It is critical to conduct a comprehensive scoping review of previous efforts to identify food safety knowledge gaps, explore the factors impacting knowledge levels, and synthesize the effectiveness of all types of food safety educational interventions for commercial and residential food handlers in China. This review aims to analyze food safety education studies published over the past 20 years and provide foundations for developing more effective food safety educational interventions in China. A total of 35 studies were included in this review. Most studies reported that Chinese commercial and residential food handlers had insufficient food safety knowledge, especially in the areas of foodborne pathogens and safe food-handling practices. The factors impacting food handlers' knowledge levels included education level, gender, income level, residency (rural vs. urban), the use of WeMedia, college students' major, and food safety training experiences. Food handlers in the following demographic groups tend to have lower levels of food safety knowledge: lower education levels, the elderly, males, lower-income levels, rural residents, those who do not use WeMedia, those without food safety training experience, or college students in nonbiology-focused majors. Many food handlers did not always follow recommended food safety practices, such as proper meat handling practices, handwashing practices, and cleaning and sanitation practices. Thirteen studies evaluated the effectiveness of educational interventions, and knowledge increases were reported after all interventions. The findings of this review provide guidance to researchers, educators, and government agencies in their future efforts to develop education programs emphasizing the importance of microbial food-safety content and behavior change regarding food safety and hygiene practices.

Review of Quantitative Microbial Risk Assessment in Poultry Meat: The Central Position of Consumer Behavior

Food of animal origin, especially meat products, represent the main vehicle of foodborne pathogens and so are implicated in foodborne outbreaks. Poultry meat is a widely consumed food in various forms, but it is also a reservoir of thermotolerant Campylobacter and Salmonella bacterial species. To assess human health risks associated with pathogenic bacteria in poultry meat, the use of quantitative microbial risk assessment (QMRA) has increased over the years as it is recognized to address complex food safety issues and is recommended by health authorities. The present project reviewed poultry meat QMRA, identified key steps of the farm-to-fork chain with significant impacts on food safety, highlighted current knowledge gaps, and provided risk mitigation advices. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-based systematic analysis was carried out and enabled the collection of 4056 studies including 42 QMRA kept for analysis after screening. The latter emphasized Campylobacter spp. and Salmonella spp. contaminations during the consumer stage as the main concern. The role of consumer handling on cross-contamination and undercooking events were of major concern. Thus, proper hygiene and safety practices by consumers have been suggested as the main intervention and would need to be followed with regular surveys to assess behavior changes and reduce knowledge gaps.

Contribution of Foods and Poor Food-Handling Practices to the Burden of Foodborne Infectious Diseases in France

The foodborne disease burden (FBDB) related to 26 major biological hazards in France was attributed to foods and poor food-handling practices at the final food preparation step, in order to develop effective intervention strategies, especially food safety campaigns. Campylobacter spp. and non-typhoidal Salmonella accounted for more than 60% of the FBDB. Approximately 30% of the FBDB were attributed to 11 other hazards including bacteria, viruses and parasites. Meats were estimated as the main contributing food category causing (50-69%) (CI90) of the FBDB with (33-44%), (9-21%), (4-20%) (CI90) of the FBDB for poultry, pork and beef, respectively. Dairy products, eggs, raw produce and complex foods caused each approximately (5-20%) (CI90) of the FBDB. When foods are contaminated before the final preparation step, we estimated that inadequate cooking, cross-contamination and inadequate storage contribute for (19-49%), (7-34%) and (9-23%) (CI90) of the FBDB, respectively; (15-33%) (CI90) of the FBDB were attributed to the initial contamination of ready-to-eat foods-without any contribution from final food handlers. The thorough implementation of good hygienic practices (GHPs) at the final food preparation step could potentially reduce the FBDB by (67-85%) (CI90) (mainly with the prevention of cross-contamination and adequate cooking and storage).

A Systematic Review and Meta-Analysis of the Effects of Food Safety and Hygiene Training on Food Handlers

Foodborne diseases are a significant cause of morbidity and mortality worldwide. Studies have shown that the knowledge, attitude, and practices of food handlers are important factors in preventing foodborne illness. The purpose of this research is to assess the effects of training interventions on knowledge, attitude, and practice on food safety and hygiene among food handlers at different stages of the food supply chain. To this end, we conducted a systematic review and meta-analysis with close adherence to the PRISMA guidelines. We searched for training interventions among food handlers in five databases. Randomized control trials (RCT), quasi-RCTs, controlled before-after, and nonrandomized designs, including pre-post studies, were analyzed to allow a more comprehensive assessment. The meta-analysis was conducted using the random-effects model to calculate the effect sizes (Hedges's g) and 95% confidence interval (CI). Out of 1094 studies, 31 were included. Results showed an effect size of 1.24 (CI = 0.89-1.58) for knowledge, an attitude effect size of 0.28 (CI = 0.07-0.48), and an overall practice effect size of 0.65 (CI = 0.24-1.06). In addition, subgroups of self-reported practices and observed practices presented effect sizes of 0.80 (CI = 0.13-1.48) and 0.45 (CI = 0.15-0.76) respectively.

The Effect of Food Handler Certification on Food Premises in Ontario, Canada

Although health units have implemented food handler certification to operators of food premises, evidence on its effectiveness to improve premise food safety remains inconclusive. Regression models were constructed using inspection data from a health unit in Ontario, Canada, to measure the effect of certification on premise inspection results. We found that premises without certified food handlers at the time of inspection were significantly more likely to fail inspections. The odds of inspection failure were significantly different depending on the premise's cultural cuisine classification. Independently owned establishments had lower odds of inspection failure versus chain operations. Inspector was a significant random effect explaining a small percentage of data variations. These results support the use of food handler certification to improve food safety outcomes at establishments. Further efforts should ensure training programs are accessible and relatable to premise operators, particularly those serving all types of cultural cuisines.

A new interministerial strategy for the promotion of healthy eating in Portugal: implementation and initial results

OBJECTIVE

To describe the implementation, main intervention areas and initial results of the Integrated Strategy for the Promotion of Healthy Eating (EIPAS) in Portugal.

METHODS

EIPAS was published as a Law, in December of 2017, as a result of a collaboration between several ministries, including the Finance, Internal Affairs, Education, Health, Economy, Agriculture, and Sea Ministries, aiming at improving the dietary habits of the Portuguese population. The working group, led by the Ministry of Health, developed this strategy for over a year. The framework produced was based on WHO and European Commission recommendations as well as on relevant data from the last Portuguese dietary intake survey (2015/2016). EIPAS also reflects the results of a public hearing, including the food industry, among others, and the experience gathered, since 2012, through the National Programme for the Promotion of Healthy Eating. It considers the 'health in all policies' challenge set by WHO and has four different strategic areas, namely (1) creation of healthier food environments, (2) improvement of the quality and accessibility of healthy food choices for consumers, (3) promotion and development of literacy, in order to encourage healthy food choices, and (4) promotion of innovation and entrepreneurship. In order to achieve these goals, a set of 51 actions was established and assigned to the seven ministries involved.

RESULTS

Under the scope of this strategy, Portugal has already implemented several actions, including (1) definition of standards for food availability at all public healthcare institutions; (2) implementation of a sugar tax on sweetened beverages; (3) implementation of a voluntary agreement with the food industry sector for food reformulation (work in progress); (4) design of a proposal for an interpretative model of front-of-pack food labelling; (5) improvement of the nutritional quality of food aid programmes for low-income groups; and (6) regulation of marketing of unhealthy foods to children.

CONCLUSIONS

For the first time, Portugal has a nutrition policy based on the WHO concept of 'health in all policies' and on the national data on food intake. The implementing process of all 51 actions and the inherent complexities and difficulties found so far have made this process be an authentic political and social laboratory that deserves to be followed.

Personal Involvement Moderates Message Framing Effects on Food Safety Education among Medical University Students in Chongqing, China

OBJECTIVE

This study explored whether the efficacy of food safety education interventions can be increased by message framing among medical university students, and demonstrated the role of personal involvement within the message recipient in moderating framed effects.

METHODS

A cross-sectional study of food safety message framing was conducted among medical university students (randomly selected 1353 participants). An online self-administered questionnaire was used to collect information. Wilcoxon rank-sum test and Ordered multivariate logistic regression were utilised in the data analyses.

RESULTS

The present study showed significant differences in acceptance between the gain- and loss-framed groups (p < 0.001). Participants with higher personal involvement had higher acceptance than those with low personal involvement in gain- and loss-framed message models (p < 0.001). The acceptance of participants who were concerned about their health condition was higher than those who were neutral regarding their health condition (p < 0.001) and participants who suffered a food safety incident had higher acceptance than those who did not (p < 0.05).

CONCLUSIONS

This study portrayed the selection preference of message framing on food safety education among medical university students in southwest China. Participants exposed to loss-framed messages had higher message acceptance than those exposed to gain-framed messages. Personal involvement may affect the food safety message framing. Public health advocates and professionals can use framed messages as a strategy to enhance intervention efficacy in the process of food safety education.

Observation of High School Students' Food Handling Behaviors: Do They Improve following a Food Safety Education Intervention?

Youth are a key audience for food safety education. They often engage in risky food handling behaviors, prepare food for others, and have limited experience and knowledge of safe food handling practices. Our goal was to investigate the effectiveness of an existing food handler training program for improving safe food handling behaviors among high school students in Ontario, Canada. However, because no schools agreed to provide control groups, we evaluated whether behaviors changed following delivery of the intervention program and whether changes were sustained over the school term. We measured 32 food safety behaviors, before the intervention and at 2-week and 3-month follow-up evaluations by in-person observations of students ( n = 119) enrolled in grade 10 and 12 Food and Nutrition classes ( n = 8) and who individually prepared recipes. We examined within-student changes in behaviors across the three time points, using mixed effects regression models to model trends in the total food handling score (of a possible 32 behaviors) and subscores for "clean" (17 behaviors), "separate" (14 behaviors), and "cook" (1 behavior), adjusting for student characteristics. At baseline, students ( n = 108) averaged 49.1% (15.7 of 32 behaviors; standard deviation = 5.8) correct food handling behaviors, and only 5.5% (6) of the 108 students used a food thermometer to check the doneness of the chicken (the "cook" behavior). All four behavior score types increased significantly ∼2 weeks postintervention and remained unchanged ∼3 months later. Student characteristics (e.g., having taken a prior food handling course) were not significant predictors of the total number of correctly performed food handling behaviors or of the "clean" or "separate" behaviors, working or volunteering in a food service establishment was the only characteristic significantly associated with food thermometer use (i.e., "cook"). Despite the significant increase in correct behaviors, students continued to use risky practices postintervention, suggesting that the risk of foodborne disease remained.

Barriers and Facilitators to Safe Food Handling among Consumers: A Systematic Review and Thematic Synthesis of Qualitative Research Studies

Foodborne illness has a substantial health and economic burden on society, and most cases are believed to be due to unsafe food handling practices at home. Several qualitative research studies have been conducted to investigate consumers' perspectives, opinions, and experiences with safe food handling at home, and these studies provide insights into the underlying barriers and facilitators affecting their safe food handling behaviours. We conducted a systematic review of previously published qualitative studies in this area to synthesize the main across-study themes and to develop recommendations for future consumer interventions and research. The review was conducted using the following steps: comprehensive search strategy; relevance screening of abstracts; relevance confirmation of articles; study quality assessment; thematic synthesis of the results; and quality-of-evidence assessment. A total of 39 relevant articles reporting on 37 unique qualitative studies were identified. Twenty-one barriers and 10 facilitators to safe food handling were identified, grouped across six descriptive themes: confidence and perceived risk; knowledge-behaviour gap; habits and heuristics; practical and lifestyle constraints; food preferences; and societal and social influences. Our overall confidence that each barrier and facilitator represents the phenomenon of interest was rated as high (n = 11), moderate (11), and low (9). Overarching analytical themes included: 1) safe food handling behaviours occur as part of a complex interaction of everyday consumer practices and habituation; 2) most consumers are not concerned about food safety and are generally not motivated to change their behaviours based on new knowledge about food safety risks; and 3) consumers are amenable to changing their safe food handling habits through relevant social pressures. Key implications and recommendations for research, policy and practice are discussed.

Food safety knowledge of undergraduate students at a Canadian university: results of an online survey

Background

Foodborne diseases are an important public health issue, and young adults are an important demographic to target with food safety education. Our objective was to assess the food safety knowledge of undergraduate students at a Canadian university, to identify potential areas for such education.

Methods

In February 2015, we conducted an online survey of 485 undergraduate students at a university in Ontario, Canada. We assessed various food-related factors, including cooking frequency and prior food handling or preparation education. We then modeled the relationship between ‘overall knowledge score’ and the demographic and food skills/cooking experience predictors using multivariable log-binomial regression, to determine factors associated with relatively higher proportions of correct responses.

Results

Respondents were, on average, 20.5 years old, and the majority (64.8 %) lived off campus. Students cooked from basic ingredients infrequently, with 3 in 4 doing so a few times a year to never. Students averaged 6.2 correct answers to the 11 knowledge questions. Adjusting for other important covariates, older age and being a current food handler were associated with relatively higher knowledge, whereas working/volunteering in a hospital and infrequent cooking were associated with relatively lower knowledge. Males in the Faculty of Science had relatively higher knowledge than females in the Faculty of Science, both of whom had relatively higher knowledge than all students in other Faculties. Among students who had never taken a food preparation course, knowledge increased with self-reported cooking ability; however, among students who had taken such a course, knowledge was highest among those with low self-reported cooking ability.

Conclusions

Consistent with other similar studies, students in Faculties outside of the Faculty of Science, younger students, and those who cook infrequently could benefit from food safety education. Supporting improved hand hygiene, in particular clarifying hand washing versus hand sanitizing messages, may also be important. Universities can play a role in such education, including as part of preparing students for work or volunteer placements, or as general support for student health and success.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3818-y) contains supplementary material, which is available to authorized users.