Insufficient Answer During the Public Health Emergency: A Lesson from the Persistence of Food Insecurity in Low-Income Communities

Cohort study in deprived communities to investigate the persistence of food insecurity (FI) during the COVID-19 was conducted. Sample were derived from a list of mobile phone numbers provided by community leaders and local nonprofit organizations. Temporal trends and prevalence ratios of FI persistence, categorized as "never," "occasional FI," "consistent FI," were calculated. A total of 302 households completed three assessments, the majority nonwhite women. During the follow-up, families covered by social assistance increased; however, their income decreased (p < 0.05). 33% were "consistent," and 46% "occasional" FI. Permanent difficulties accessing gas canisters, hygiene products, and hand sanitizers were observed.

Food handlers' lack of knowledge, and misunderstanding of safe food temperatures: An analysis using the theory of social representations

Comprehension is the ability to understand and be familiar with situations and facts. A critical factor causing foodborne diseases is the inadequate temperature during food storage and handling; food handlers often fail to understand this. Therefore, in this study, we investigated how technical language and everyday knowledge operate in the comprehension of safe food temperatures among food handlers in food services. To achieve this, data collection was carried out in two stages. In the first stage, a survey was conducted to 206 food handlers from 14 food service working in the city of São Paulo. Through this survey, we gathered information to characterize the socio-demographic profile of the sample, details about participation in training, and knowledge of technical terms related to safe food temperatures. In the second stage, individuais interviews were conducted on the same day following the questionnaire administration in each food service. A total of 29 interviews were carried out An interview script was developed containing two storylines based on the Fourth Key: "Keep food at safe temperatures," which is part of the WHO's "Five Keys to Safer Food" manual. Further, the collective subject discourse technique, which is based on the theory of social representations, was employed to analyze each interview and construct a representative collective discourse. Analysis of the results indicated that lack of knowledge about safe food temperatures is mainly a result of the misunderstanding of technical terms. The collective discourses obtained results reinforced that food handlers had diverse and erroneous information about food defrosting, and they exhibited low confidence and clarity about safe food temperatures. Overall, psychological, social, and cultural factors affect the formation of social representations that guide food handlers' decision-making.

Do Brazilian consumers intend to use food labels to make healthy food choices? An assessment before the front-of-package labelling policy

Front-of-package labelling is a measure that can facilitate consumption of healthier foods. This study examined the predictors of consumers' intentions to use food labelling to make healthy food choices and prevent non-communicable diseases before the implementation of the front-of-package labelling policy in Brazil. An extended theory of planned behaviour incorporating knowledge and food literacy served as the theoretical foundation. First, experts (n = 6) and the target population (n = 30) validated the questionnaire, and the validation data were analysed using content validity coefficients (CVC). An online questionnaire was administered to 783 participants, and data were collected between May and October 2022. Partial least squares structural equation modelling (PLS-SEM) was used to test the prediction hypothesis. The questionnaire showed adequate content validity, with all indicators of CVC ≥ 0.75. In the PLS-SEM attitudes (p < 0.001), subjective norms (p < 0.001), knowledge (p < 0.001), and food literacy (p < 0.001) positively predicted the intention to use food labels to make healthy food choices, confirming the main hypothesis. Also, Food literacy and knowledge predicted all constructs of the theory of planned behaviour (p < 0.001). The results highlight the importance of providing nutritional knowledge and food literacy, developing nutritional skills and abilities to encourage consumers to make healthy food choices, and to strengthen other policies such as front-of-package labelling.

Exploring dark kitchens in Brazilian urban centres: A study of delivery-only restaurants with food delivery apps

Dark kitchen is a delivery-only restaurant that operates without direct contact with the consumer, has no premises for local consumption and sells exclusively through online platforms. The main objective of this work is to identify and characterise dark kitchens in three urban centres featured in the most used food delivery app in Brazil. To this end, data collection was conducted in two phases. In the first phase, through data mining, we collected information from restaurants in three cities (Limeira, Campinas and São Paulo - Brazil) that were provided in the food delivery app. A total of 22,520 establishments were searched from the central point of each of the cities. In the second phase, the first 1,000 restaurants in each city were classified as dark kitchens, standard, or undefined restaurants. A thematic content analysis was conducted to further distinguish the dark kitchen models. Of the restaurants evaluated, 1,749 (65.2%) were classified as standard restaurants, 727 (27.1%) as dark kitchens, and 206 (7.7%) as undefined. In terms of the characteristics of dark kitchens, they were more dispersed and located further away from the central points compared to standard restaurants. Meals in dark kitchens were cheaper than in standard restaurants, and had a lower number of user reviews. Most of the dark kitchens in São Paulo served Brazilian dishes, while in the smaller cities, Limeira and Campinas, it was mainly snacks and desserts. Six different models of dark kitchen were identified: Independent dark kitchen; shell-type (hub); franchise; virtual kitchen in a standard restaurant (different menu); virtual kitchen in a standard restaurant (similar menu but different name); and home-based dark kitchen. The modelling approach and methodology used to classify and identify dark kitchens is considered a contribution to science as it allows a better understanding of this fast growing sector of the food industry. This in turn can help to develop management strategies and policies for the sector. Our study is also of value to regulators to determine their proliferation through urban planning and to promote appropriate guidelines for dark kitchens as they differ from standard restaurants.

Reproducibility and Validity of a Self-Administered Food Safety Assessment Tool on Children and Adolescent's Risk Perception, Knowledge, and Practices

The present study aimed to verify the instrument's reliability and validity for assessing children and adolescents' risk perception, knowledge, and food safety practices in the school context. Moreover, it aimed to test the hypothesis that both application methods (paper and pencil (PAPI) and online) are valid. The instrument comprised three questionnaires and followed a strict protocol to combine online and PAPI models, resulting in five application forms. The sample consisted of 439 Brazilian students from 10 to 14 years old (y/o). The results related to reliability and validity indicated that the knowledge questionnaire presented adequate stability and discriminant validity coefficients. The self-reported practices questionnaire obtained acceptable coefficients of stability and internal consistency. Regarding risk perception data, it was observed that students attribute a low probability of Foodborne Diseases (FBD) outbreaks occurrence and low severity of possible symptoms. In addition, students demonstrated insufficient knowledge and inadequate practices on issues related to failures associated with the time and temperature of preparation, storage, and exposure of food, contamination of food, and consumption of unsafe food. In this context, the reproducibility and validity indices need to be interpreted and discussed correctly, and young people in food safety actions are a priority in facing FBD.

Job Crafting and Burnout as Predictors of Food Safety Behaviors in the Foodservice Industry

This study aimed to investigate whether job crafting, burnout, and work engagement predict food safety behaviors in the foodservice industry. It was a cross-sectional study conducted in Cuiabá (Brazil) among foodservice workers. Four instruments were used among foodservice workers for the examination: (a) job demands and resources, (b) job satisfaction, (c) burnout, and (d) work engagement. Food safety practices were measured using a validated risk-based checklist. Partial least squares structural equation modeling was used to test the hypothesis model. In this study, 22 restaurants and 302 foodservice workers were examined. It was found that the “job demands-resources” model was valid for foodservice workers, i.e., burnout was strongly predicted by job demands (β = 0.550; p < 0.001); job resources were a positive predictor of work engagement (β = 0.258; p < 0.001); and burnout was a negative predictor of work engagement (β = −0.411; p < 0.001). Food safety violations were predicted by job crafting (β = −0.125; p = 0.029) and burnout (β = 0.143; p = 0.016). The results indicate that mitigating burnout and increasing job crafting can be important supporting strategies to improve food safety behaviors.

Inocuidad y calidad del agua y alimentación escolar: enfoques en América Latina y el Caribe

Objetivo.

Identificar los enfoques sobre la inocuidad y calidad del agua en los documentos que describen los programas de alimentación escolar en los países de América Latina y el Caribe (ALC).

Métodos.

Estudio descriptivo, transversal y exploratorio de los documentos sobre alimentación escolar en los países y territorios de ALC. Se realizó el análisis documental y se determinaron a priori cuatro categorías: “agua para el consumo”, “agua para la higiene”, “agua para la preparación”, y “agricultura local/familiar” según el uso del agua en la alimentación escolar. Los documentos fueron buscados durante 2018-2019 en los sitios web oficiales de los países y territorios de ALC, la Organización de las Naciones Unidas para la Alimentación y Agricultura y el Programa Mundial de Alimentos. Se obtuvieron las frecuencias absolutas y relativas de los datos cuantitativos y para los datos cualitativos se aplicó el análisis de contenido del tipo temático.

Resultados.

Se analizaron 114 documentos, de los cuales 29 eran elegibles. Los enfoques de las categorías “agua para el consumo”, “agua para la higiene” y “agua para la preparación” solo atribuían al agua la característica de ser potable. En la categoría “agricultura local/familiar” no se encontraron enfoques sobre el agua para el riego.

Conclusión.

Los documentos abordan el agua, pero no se centran en su inocuidad y calidad. Los gobiernos y autoridades locales deben revisar sus documentos y garantizar la unanimidad de los enfoques a partir del apoyo y diálogo intersectorial para alcanzar las metas de los Objetivos de Desarrollo Sostenible.

What Motivates Consumer Food Safety Perceptions and Beliefs? A Scoping Review in BRICS Countries

This scoping review aimed to map the main evidence in the existing literature regarding consumer perceptions and beliefs regarding food safety in the context of BRICS (Brazil, Russia, India, China, and South Africa) countries. Articles were searched in the Web of Science, Scopus, and SciELO databases. The last search was performed on November 2021. Only the studies conducted within BRICS countries were included. The synthesis aimed to group similarities in consumer beliefs and perceptions of food safety. After screening, 74 eligible articles were included in the study. Of the 74 studies analyzed, 49 (66.2%) were carried out in China, 14 (18.9%) in Brazil, 5 (6.8%) in India,4 (5.4%) in South Africa, and 2 (2.7%) in Russia. Thirty-three motivators of perceptions and beliefs regarding food safety were identified. Food safety motivators were grouped into three categories: (1) sociodemographic characteristics, (2) cognitive aspects, and (3) other. In the “sociodemographic characteristics” category, the motivator with the highest number of corresponding results was education level (results = 22), followed by income (results = 22), both positive drivers for food safety perceptions. The “cognitive aspects” category comprised the majority of the identified motivators. Concern for food safety (results = 32) and risk perception (results = 30) were the motivators with the highest number of results among all categories and motivators. Finally, the main motivator in the “other” category was place of consumption/purchase (results = 8), focusing on consumers underestimating the risk of having a foodborne disease when eating away from home. China and Brazil are leading the way in studies on this topic. Consumers’ perceptions are influenced by socioeconomic characteristics (e.g., age, gender, education level, income), cognitive aspects (e.g., knowledge, risk perception, food concerns, previous experience with food safety incidents) and other situational factors (e.g., price, place of purchase, traceability).

Behavioral predictors of household food-safety practices during the COVID-19 pandemic: Extending the theory of planned behavior

The epidemiological scenario of COVID-19, social distancing, and business restrictions has increased food preparation and consumption at home. Food mishandling at home can significantly raise the risk of foodborne diseases. This study investigates food-mishandling behavior predictors by applying the extended theory of planned behavior (TPB), with the addition of knowledge and risk perception, to households during the COVID-19 pandemic. One thousand and sixty-eight consumers (n = 1068) in Brazil participated in this study before the COVID-19 vaccination period. Data were collected using an online questionnaire with 40 questions and different anchors; they were analyzed using structural equation modeling. The following original TPB factors positively affected the intention to implement safe food-handling practices: attitude (p < 0.001), perceived behavioral control (p < 0.001), and subjective norms (p < 0.001). More robust effects of attitude and perceived behavioral control on intention were also observed. Although food-safety knowledge did not affect intention (p = 0.30), it positively affected the other TPB factors. Perceived risk positively affected all TPB factors. The results of this study support the usefulness of TPB and its extension, providing evidence that public-health crises can contribute to changes in food-safety-related consumer behavior.

Psychological distress, low-income, and socio-economic vulnerability in the COVID-19 pandemic

OBJECTIVES

Although literature broadly reports the impact of COVID-19 on global mental health, little is known about the extent of its deleterious impact on the most vulnerable individuals. The present study aimed to evaluate the level of psychological distress of adult's residents of two urban shantytown communities located in São Paulo city, Brazil.

STUDY DESIGN

This was a cross-sectional study.

METHODS

An online questionnaire was divided into four sections: (1) informed consent, (2) socio-economic data, (3) 12-item general health questionnaire, and (4) Brazilian food insecurity scale was applied.

RESULTS

Of the 495 family headship (448 females and 47 males), the mean age was 36.1 years, 85% have an indication of psychological distress, 61.4% had a monthly income less than or equal to $70, and the incidence of households experiencing moderate or severe food insecurity was 40%. Multivariate logistic regression revealed that respondents who experienced moderate or severe food insecurity (odds ratio [OR] = 2.701, confidence interval [CI] 95% = 1.265-5.769; P = 0.010) and lower monthly income (OR = 2.031, CI 95% = 1.056-3.908; P = 0.034) had a higher risk of psychological distress. On the other hand, having an employment is a protective factor against the stressful situations caused by COVID-19 pandemic (P = 0.029).

CONCLUSION

The present study identified low-income younger women residents of urban slums who suffer from food insecurity as high-risk groups to have psychological distress. Our findings are of particular importance because they showed the intersection of vulnerabilities during the COVID-19 outbreak.

Work Conditions, Social Incorporations, and Foodborne Diseases Risk: Reflections About the (Non)Compliance of Food Safety Practices

The number of foodborne diseases has increased in all continents, and efforts must be made to control this urgent and expressive public health problem. This article aims to present and discuss situations related to the compliance and noncompliance of food safety practices (FSPs) in light of Bourdieu's social theory. This qualitative study was conducted in commercial restaurants in two cities in São Paulo, Brazil. Participant observation was used in the restaurants, and notes referring to the kitchen workers and their bosses' work processes were registered in field journals. Thematic type content analysis was used to determine the meaning cores of field journals. It was found that aspects inherent to convenience and haste at work, deficient infrastructure, lack of employees, negative boss examples, exposure to noise, and body pain experienced by workers can contribute to noncompliance of FSPs and consolidate in the habitus and practical sense some dispositions that can increase the risk of foodborne diseases. This study highlights the necessity of creating environments that address food safety, which means being able to perform a service properly.

The differences between observed and self-reported food safety practices: A study with food handlers using structural equation modeling

Every year, studies about food handlers' food safety knowledge, attitudes, and practices are published. Some results of these papers have been rather controversial, especially those related to food safety practices. The two most common methods for evaluating food safety practices - self-assessment and observation - are generally treated as interchangeable, but they can have different meanings. The objective of this study was, therefore, to differentiate between the observed and self-reported food safety practices of food handlers, verifying the effect of different variables in these food safety indicators through structural equation modeling, and examining the relationship between cognitive factors and these practices. A questionnaire with 37 questions was given to 183 food handlers to evaluate their food safety knowledge, attitudes, self-reported practices, and risk perceptions. For the observed assessment method of evaluating the food handlers' practices (observed practices), a checklist was developed, and food handlers were observed during one workday. Two models were developed based on the results of these two assessment methods. In the first model a significant positive effect of knowledge and a negative effect of risk perception on self-reported practices were observed. Food handlers with high risk-perception about their practices reported less adequate practices. Positive food safety attitudes acted as a moderator dampening the positive effect between knowledge and self-reported practices. In the second model a significant positive effect of knowledge on observed practices. Attitudes strengthened the positive effect between knowledge and observed practices. On the other hand, a direct effect of attitude on observed practices was not observed. In conclusion, self-reported practices and observed practices are different and should be used and discussed properly.

Food safety performance and risk of food services from different natures and the role of nutritionist as food safety leader

Abstract The objective of this study was to evaluate the food safety performance of food services and its associated factors. The study involved 84 food businesses in the city of Santos as follows: street food kiosks and beach kiosks (street food), commercial restaurants, hospitals and school meal services (institutional food services). A food safety checklist with 81 items was applied. The overall percentage of adequacy was lower in street food kiosk (49.7%) and beach kiosk (62.0%) than in restaurants (69.7%), hospitals (83.9%) and schools (86%). Institutional and commercial restaurants showed higher scores of food safety performance than street food services, mainly regarding risker practices. The variables positively associated with food safety performance in commercial restaurants were: presence of a nutritionist as leader and adequate structure. These results show that street food services need, in a mediate way, the implementation of new strategies and regulations to improve food safety. A nutritionist acting as food safety leader may improve the food safety performance at commercial restaurants.

Inspection Score and Grading System for Food Services in Brazil: The Results of a Food Safety Strategy to Reduce the Risk of Foodborne Diseases during the 2014 FIFA World Cup

In 2014, Brazil hosted one of the most popular sport competitions in the world, the FIFA World Cup. Concerned about the intense migration of tourists, the Brazilian government decided to deploy a food safety strategy based on inspection scores and a grading system applied to food services. The present study aimed to evaluate the results of the food safety strategy deployed during the 2014 FIFA World Cup in Brazil. To assess food safety, an evaluation instrument was applied twice in 1927 food service establishments from 26 cities before the start of the competition. This instrument generated a food safety score for each establishment that ranged from 0.0 (no flaws observed) to 2565.95, with four possible grades: A (0.0-13.2); B (13.3-502.6); C (502.7-1152.2); and pending (more than 1152.3). Each food service received a stamp with the grade of the second evaluation. After the end of the World Cup, a study was conducted with different groups of the public to evaluate the acceptance of the strategy. To this end, 221 consumers, 998 food service owners or managers, 150 health surveillance auditors, and 27 health surveillance coordinators were enrolled. These participants completed a survey with positive and negative responses about the inspection score system through a 5-point Likert scale. A reduction in violation scores from 393.1 to 224.4 (p < 0.001) was observed between the first and second evaluation cycles. Of the food services evaluated, 38.7% received the A stamp, 41.4% the B stamp, and 13.9% the C stamp. All positive responses on "system reliability" presented a mean of 4.0 or more, indicating that the public believed this strategy is reliable for communicating risks and promoting food safety. The strategy showed positive results regarding food safety and public acceptance. The deployed strategy promoted improvements in the food safety of food services. The implementation of a permanent policy may be well accepted by the public and may greatly contribute to a reduction in foodborne diseases (FBDs).

Uma experiência de integração ensino-serviço e a mudança de práticas profissionais: com a palavra, os profissionais de saúde

Objetivou-se analisar as mudanças nas práticas em saúde a partir da inserção das atividades de uma universidade pública na atenção básica em saúde de Santos, SP, Brasil. Trata-se de pesquisa qualitativa com profissionais da atenção básica em saúde envolvidos em ações de ensino e extensão da universidade. Alguns entrevistados relatam não participar do planejamento conjunto das atividades e reiteram a dicotomia entre teoria e prática. Os profissionais apontam potencialidades na integração ensino-serviço-comunidade no que diz respeito a mudanças das práticas, entendendo que a universidade não substitui o serviço, mas propicia um momento de pausa e discussão, que permite mudar a forma de se relacionar e perceber os problemas dos usuários, de repensar a concepção de saúde, cuidado e trabalho em equipe, além de favorecer o estudo e o contato com novas ferramentas/formas de trabalho.

Should Weights and Risk Categories Be Used for Inspection Scores To Evaluate Food Safety in Restaurants?

The objective of this study was to verify the characteristics of food safety inspections, considering risk categories and binary scores. A cross-sectional study was performed with 439 restaurants in 43 Brazilian cities. A food safety checklist with 177 items was applied to the food service establishments. These items were classified into four groups (R1 to R4) according to the main factors that can cause outbreaks involving food: R1, time and temperature aspects; R2, direct contamination; R3, water conditions and raw material; and R4, indirect contamination (i.e., structures and buildings). A score adjusted for 100 was calculated for the overall violation score and the violation score for each risk category. The average violation score (standard deviation) was 18.9% (16.0), with an amplitude of 0.0 to 76.7%. Restaurants with a low overall violation score (approximately 20%) presented a high number of violations from the R1 and R2 groups, representing the most risky violations. Practical solutions to minimize this evaluation bias were discussed. Food safety evaluation should use weighted scores and be risk-based. However, some precautions must be taken by researchers, health inspectors, and health surveillance departments to develop an adequate and reliable instrument.

The existence of optimistic bias about foodborne disease by food handlers and its association with training participation and food safety performance

A positive outlook regarding future events, in which individuals find themselves less likely than others to experience negative events, is called optimistic bias (OB). The aims of this study were: 1. To ascertain the existence and measure the OB phenomenon in food handlers in relation to foodborne disease and 2. To examine the association of OB with food handlers' risk perceptions, knowledge, attitudes, self-reported practices, training participation, food safety performance of the establishments and microbiological analysis. This study examined different food businesses in Santos city, in Brazil, as follows: street food kiosks, beach kiosks, restaurants, hospitals, and school meal services. The food handlers indicated their own risk and their peers' risk of causing a foodborne disease. Responses were given on a 10cm linear scale anchored with descriptors of intensity ranging from "none" to "very high". The difference between these risk perceptions characterized a score of tendency of an OB. A structured questionnaire was administered to evaluate knowledge, attitudes, self-reported practices and food safety performance. A total of 183 food handlers participated in the study. Microbiological analyses were conducted with ready-to-eat foods/preparations from selected sites. The food handlers perceived themselves as less likely than their peers to cause a foodborne disease (p<0.001), demonstrating the tendency of an OB. Food handlers who had undergone some training presented lower scores for the perceived risk of themselves being responsible for a foodborne disease and higher knowledge than did untrained individuals. Hospitals, schools and restaurants performed better than street food group considering food safety performance. However, microorganisms were found in food samples from hospitals. This result may be motivated by OB and other subjective factors. Apparently, this positive outlook of food handlers is associated with training participation, lethality perception and correlating positively with age. No association was found between OB scores and knowledge, attitudes and self-reported practices. Since OB may lead individuals to adopt inappropriate or dangerous behavior, strategies for debiasing food handlers should be designed.

Regional food dishes in the Brazilian National School Food Program: Acceptability and nutritional composition

Objective: the objective of this study was to evaluate the nutritional composition and describe the acceptability of regional culinary dishes served to students from public schools of rural and urban areas. Methods: Ten Brazilian regional dishes were evaluated for acceptability and nutritional composition. the survey was conducted in schools located in rural and urban areas of two cities in the state of São Paulo. Dish acceptability was evaluated using leftover analysis and a 5-point facial hedonic scale. the adherence index was calculated and used as an indirect measure of acceptance, and the nutritional composition was calculated based on the technical files of each dish. Results: A total of 2,384 students from 20 schools participated in the study and 1,174 tasted and evaluated the dishes. the test using the 5-point facial hedonic scale demonstrated that five dishes (Caldo verde soup, persimmon jelly, chicken with okra, puréed cornmeal with spinach, and arugula pizza) had an acceptability rate above 85.0%. the mean adherence indices were 57.3% and 55.6% in urban and rural environments, respectively. Analysis of the nutritional composition of regional dishes indicates that these dishes can partially meet macronutrient recommendations. Conclusion: the tested dishes can become part of school menus as they were accepted or partly accepted by the students regardless of school location, whether rural or urban. the cultural heritage is an important resource for the food sovereignty of a country and should be constantly encouraged.

[Instrument for assessment of best practices in school food and nutrition units: from design to validation]

The scope of this study was to elaborate and validate an assessment tool for Best Practices in School Food and Nutrition Units. For this purpose a survey was conducted in the city of Santos (São Paulo - Brazil), in two stages: 1) Preparation of a Checklist for Best Practices in School Food and Nutrition Units (BPAE checklist). 2) Validation of the BPAE checklist. This checklist was applied in 76 public schools along with two other reference checklists. Sensitivity and specificity were estimated using the Receiver Operating Characteristics (ROC) Curve and the checklist was evaluated by application of the Likert scale. The thematic groups received weights to calculate the percentage of adequacy. After the application of the checklists in schools, the area under the curve value of 0.79 was found for the SS-196 checklist and 0.85 for the 542/2006 administrative checklist. These values indicate good suitability of the BPAE checklist to identify inadequacies, and it also received a positive assessment from the school food nutritionists. It proved that the checklist will assist in decision-making to ensure quality control. Once the BPAE checklist has been fully tested and validated it should prove an important tool for quality control in school nutrition.