Food Safety Knowledge and Behavior of Emergency Food Relief Organization Workers: Effects of Food Safety Training Intervention

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Introduction

Foodborne illness is a major cause of illness, death, and economic burden in the United States (Food and Drug Administration [FDA], Food Safety and Inspection Service [FSIS], & Centers for Disease Control and Prevention [CDC], 1999). According to CDC (1996, 2001), an estimated 76 million cases of foodborne illness occur each year in the United States, with the annual economic impact estimated to be between $6.5 billion and $34.9 billion (FDA, U.S. Department of Agriculture, U.S. Environmental Protection Agency, & CDC, 1997). It is estimated that each year 325,000 to 500,000 people are hospitalized as a result of foodborne illness in the United States and that at least 5,000 people die as a result of foodborne illness (CDC, 2001; FDA, FSIS, & CDC, 1999; Mead et al., 1999; Taege, 2002). In addition to pathogens that cause acute illness, microorganisms have been identified that can cause chronic illness (Lindsay, 1997; U.S. Department of Health and Human Services [USHHS] Public Health Service, 2000).

Foodborne illness continues to be a concern for several reasons. These include emerging pathogens, improper food preparation and storage practices among consumers, insufficient training of food workers, an increasingly global food supply, and an increase in the number of people at risk because of aging and compromised capacity to fight foodborne illnesses (USHHS Public Health Service, 2000).

Lack of education is also cited as an issue related to food safety. Home economics-type courses are not mandatory for students in school. Thus, safe food storage and preparation methods are not routinely taught (Taege, 2002). In many areas of food service, formal food safety courses are not mandated for all food workers. The food industry has high rates of turnover, which adds to the challenge of educating food workers (Almanza & Nesmith, 2004).

Food safety poses greater risk among specific groups of people. An increased number of people are at risk for foodborne illness because of a compromised ability to fight illnesses. The very young, the very old, pregnant women, and people who are ill are among those more susceptible, and they experience the most severe complications and outcomes as a result of foodborne illness. These high-risk groups represent approximately 20 percent of the American population (Smith, 1997). These people may become ill from smaller doses of microorganisms and may be more likely to die of foodborne illness than are people not in these compromised groups.

Socioeconomic factors and education level have also been identified as issues affecting food safety. While representative research data specific to racial or socioeconomic groups are limited, a report from the United Kingdom indicates a relationship between socioeconomic status and foodborne illness. The report found that hospital admissions for gastrointestinal infection rose with increasing socioeconomic deprivation (Olowokure, Hawker, Weinberg, Gill, & Sufi, 1999).

Food safety is particularly critical in emergency food programs such as food pantries, soup kitchens, and emergency shelters. Emergency food programs distribute food to a significant number of people who are particularly susceptible to foodborne illness. The Hunger in America study (Kim, Ohls, & Cohen, 2001) found that at least half of the participants receiving emergency food nationwide through America's Second Harvest fell into high-risk categories. About one in 10 were elderly, and close to 40 percent were children. Of the emergency food participants in New York State receiving food through America's Second Harvest, 13.6 percent were elderly and 37.6 percent were children. Among emergency food participants surveyed in New York State, about one-third were reported to be in poor health (Kim et al., 2001).

Besides the high-risk status of participants, emergency food programs face additional challenges that increase the risk of foodborne illness. The food used in emergency food programs often goes through many hands before being consumed. …