Food Safety Education: Child-to-Parent Instruction in an Immigrant Population
Ratnapradipa, Dhitinut, Quilliam, Daniela, Wier, Lauren, Rhodes, Darson L., Journal of Environmental Health
Approximately 76 million Americans become infected with foodborne diseases each year and it is estimated that nearly 5,000 individuals die each year as a result (Mead et al., 1999). The costs associated with foodborne diseases are very high and have been estimated to cost the U.S. as much as $35 billion annually (World Health Organization [WHO], 2007). Research indicates that mishandling of food in homes and eating establishments accounts for nearly 85% of all foodborne illness outbreaks (Hall, 1997). A recent review reported that of 816 foodborne disease outbreaks involving food workers, restaurants were the most frequently reported setting (Todd, Greig, Bartleson, & Michaels, 2007). Many of these mishandling practices occur during food preparation (Hobbs & Roberts, 1993). They tend to occur more often in restaurants than in homes and supermarkets: approximately 65% of consumer infection was attributed to food prepared at restaurants, while only 17% was attributed to mishandling at homes and 17% to mishandling at supermarkets (Fien, Lin, & Levy, 1995). From 1987 to 1992, 79% of outbreaks were caused by bacteria, largely due to food handlers' poor hygiene and improper holding temperatures (Collins, 1999). In light of the growing number of people who depend on eating meals outside the home, the impact of these data is cause for concern (Fien et al., 1995; Yang et al., 1998).
Visitors and preparations for the 2002 Olympic Games in Utah placed an increased demand on restaurant businesses, especially in Salt Lake City, where a need arose for additional restaurant workers. Many of the individuals hired to work in the local restaurant industry were recent immigrants, including eastern European refugees. Despite well-documented techniques for food preparation, food handling, and sanitation, many food service workers are unaware of or do not adhere to these standards. Immigrants, in particular, may be more likely to misunderstand or be unaware of food safety guidelines in the United States as a result of communication barriers and cultural differences in food preparation. These misunderstandings may, in turn, contribute to increased local risk of foodborne disease (Huff & Kline, 1999). Therefore, immigrants working in the food service industry may benefit especially from food safety training that will improve their job performance and aid in preventing and controlling the spread of foodborne illnesses (Foster, 1990).
Sometimes tools going beyond mere explanations of disease prevention information are needed to reach culturally diverse groups and convince them to change their behavior (Freimuth, Linnan, & Potter, 2000). By choosing the right channel of communication, including accommodating any anomalous needs, departments of health can educate food industry workers more effectively, thereby reducing the potential threat to public health and safety. Currently, the Salt Lake Valley Health Department (SLVHD) provides food handler classes in English, but most eastern European restaurant workers contacted in connection with our study did not speak English. Because immigrant children are often a primary source of their parents' understanding of a new culture (Brockette, 1998), using bilingual children of restaurant candidates to help educate parents about foodborne illnesses may be a potential solution to overcoming language barriers in communicating food safety practices.
Although many researchers emphasize that employee training programs reduce the spread of foodborne diseases, few published studies have tested the efficacy of these programs (Cohen, Reichel, & Schwartz, 2001). Moreover, to our knowledge, no prior studies have assessed the mode of delivery of food handling training in an immigrant population. Thus, the intervention described in this article was designed to examine the extent to which food handling knowledge would change among eastern European refugee restaurant candidates as a result of educational material taught either by the employee's child or the SLVHD. …