A Knowledge Assessment and Intervention to Reduce Food Poisoning Risk Factors Related to Restaurant Food Handlers

<p>NON-TECHNICAL SUMMARY: <br/>Improper handling of food is a substantial contributor to the occurrence of restaurant-associated foodborne outbreaks. The goals of this project include determining gaps in food safety knowledge among restaurant food handlers that work in suburban restaurants (including examining the influence of lack of English fluency among Spanish speaking food handlers), creating evidence-based educational interventions for this population of food handlers and assessing which is superior (a comic book versus a brochure) on its impact on knowledge and on restaurant inspection score results as well as determining if the comic book or brochure is more acceptable to each of the two language groups. This project will include knowledge surveys of suburban restaurant food handlers before and after providing them with these language appropriate educational
interventions and collection and analysis of information from restaurant inspections performed by local health departments. The project will be working with the Survey Research Laboratory and will be informed by a group of stakeholders including local health departments and the state health department.

<p>APPROACH: <br/>After stakeholder input and cognitive interviewing, the Survey Research Laboratory (SRL) will perform a survey of approximately 700 restaurant food handlers in a relatively homogeneous area of three suburban counties. The SRL will be involved in questionnaire development, sample design, pretesting the questionnaires and survey procedures. After survey data has been entered into a database and analyzed, the language appropriate brochure and comic book will be created that emphasizes the knowledge gaps of these suburban food handlers and these will be distributed to participating restaurants. The SRL will perform a follow-up interview of 248 food handlers at these restaurants. Restaurant inspection scores will also be collected for participating restaurants before and after the intervention to assess for resulting measurable behavioral changes. Statistical
analysis to measure how the interventions improve the restaurant inspection scores will include a mediational model investigating how interventions improve the restaurant inspection score through their effects on food handler knowledge. Other statistical methods will include summary statistics and crude tests and regression models. In a mixed-effects regression model, the intervention groups will be coded into two indicators of the brochure intervention and the comic book intervention. Their difference over the control group will be estimated, and the difference between these two interventions can be estimated using contrasts controlling for other covariates in the model.
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PROGRESS: 2008/09 TO 2013/08
<p>Target Audience: <br/>Through broad dissemination by publication of the results in the Journal of Environmental Health, the information from our study became available to health department personnel, food safety professionsals, and other stakeholders. The results were also presented at the IAFP meeting in Charlotte thus exposing additional food safety professionals to the results. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? The project provided MPH, MS, and PhD level students with training and practice of food safety research. How have the results been disseminated to communities of interest? The results have been and will be published in scientific journals (two articles are in press), presented to public health professionals at meetings including regional
environmental health practitioners, and presented at scientific meetings such as the annual IAFP conference. The results have also been shared with the state health department. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

<p>PROGRESS: 2010/09/01 TO 2011/08/31
<p>OUTPUTS: <br/>The report outputs described in this section reflect the study for Year Three. The study methods and timeline compliance have been met in accordance to the research protocol for the third year. December 2010 through February 2011- Educational interventions (comic book and brochure) designed to target food safety knowledge gaps determined in pre-intervention survey were disseminated to 90 restaurants in Suburban Cook, Lake, Kane and DuPage Counties in Illinois. Materials were distributed to restaurants in-person by the researchers and restaurant managers were asked to provide the educational materials to their staff. Managers were also informed that reading the materials was an eligibility requirement to participate in the upcoming post-intervention survey. February 2011- IRB approval for the English and Spanish
post-intervention consent forms and surveys was obtained. March 2011- Analysis of pre-intervention food handler surveys was completed and analysis of the pre-intervention restaurant inspection scores began. March 2011- Analysis of food handlers pre-intervention scores for DuPage County was completed. August 2011- IRB Continuing Review approval was obtained. August 2011- Pre-intervention survey results were presented as a poster at the USDA/NIFA Principal Investigators meeting in Milwaukee, Wisconsin. August 2011- Lessons learned from the study methods were presented as a poster at the annual International Association of Food Protection (IAFP) meeting in Milwaukee, Wisconsin. September 2011- Analysis of pre-intervention restaurant inspection scores was completed. September 2011- 345 post-intervention food handler surveys were completed at 135 participating restaurants; the remaining
post-intervention surveys are expected to be complete by December 2011. Data entry is complete for all post-intervention surveys performed thus far and analysis will begin once all post-intervention surveys are complete. PARTICIPANTS: Nothing significant to report during this reporting period. TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

<p>PROGRESS: 2009/09/01 TO 2010/08/31
<p>OUTPUTS: <br/>The report outputs described in this section reflect the study for Year Two. The study methods and timeline compliance have been met in accordance to the research protocol for the second year. February 2010-729 pre-intervention food handlers surveys were completed at 211 restaurants in the suburbs in Northern Illinois. April 2010- Preliminary analysis of the pre-intervention surveys began. May 2010-A Stakeholder's meeting was convened and representatives that attended included persons from local health departments (Kane, Lake, Cook, DuPage) including urban, suburban, and rural jurisdictions' Environmental Health managers, sanitarians, and communicable disease outbreak investigation staff, the Illinois Department of Public Health including the Division of Food, Drugs, and Dairies, the artist who is illustrating the
educational comic book, and the Survey Research Laboratory from the University of Illinois at Chicago School of Public Health. The agenda for this meeting included an overview of preliminary results of restaurant food handler demographics and food safety knowledge, the project's objectives and methods, and review of a draft of the restaurant food handler educational intervention materials (brochure and comic book). The educational materials were modified based on comments provided by stakeholders. June 2010- An additional 96 restaurant food handler surveys were completed in DuPage County and data entry and analysis are currently being performed. July 2010- The preliminary study results were presented as a poster at the USDA/NIFA Principal Investigators meeting in Chicago, Illinois. August 2010- The preliminary study results were presented as a poster at the annual International
Association of Food Protection (IAFP) meeting in Anaheim, California. October 2010- The evidence-based educational materials were completed, translated into Spanish and approved by the IRB. PARTICIPANTS: The following key personnel have worked on this project: Mindi Manes, PhD Epidemiology candidate is acting as the research study coordinator. Palak Panchal, MPH and PhD candidate and Anne Burke, MS candidate are current research assistants. In accordance with the Research Protocol, staff from the Survey Research Laboratory at the University of Illinois at Chicago, with the assistance of the research assistants, helped to perform the pre-intervention surveys. DuPage County santarians Maria Ruiz, Mary Jo Keinzle and Rachael Browning helped complete the food handler interviews in DuPage County. TARGET AUDIENCES: Suburban Chicago restaurant food handlers are the target audience for this
project. Evidence-based educational materials (comic book and brochure)were developed based on the food safety knowledge gaps determined by the pre-intervention survey for this population. These materials were completed in October 2010 and will be distributed to the target audience in November 2010. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.
<p>PROGRESS: 2008/09/01 TO 2009/08/31
<p>OUTPUTS: <br/>The report outputs described in this section reflect the study for Year The study methods and timeline compliance have been met in accordance to the Research protocol for this first year. Initial IRB approval for the study was obtained September 24, 2008. September 2008- Cognitive interviews at the University of Illinois at Chicago School of Public Health were performed with restaurant food handlers including 5 that are fluent in English and 5 that are fluent in Spanish to explore the suitability of survey questions as written. These interviews involved asking the survey questions with oral responses and asking interviewees to explain why they chose their responses and what the terms in the questions meant to them. These responses helped to finalize the pre-intervention survey. October 2008- A Stakeholder's meeting was
convened and representatives that attended included persons from local health departments (Kane, Lake, Cook, and Chicago) including urban, suburban, and rural jurisdictions' Environmental Health managers, sanitarians, and communicable disease outbreak investigation staff, the Illinois Department of Public Health including the Division of Food, Drugs, and Dairies, the artist who will be illustrating the educational comic book, and the Survey Research Laboratory from the University of Illinois at Chicago School of Public Health. The agenda for this meeting included an overview of data available on restaurant food handler knowledge, the project's objectives and methods, and review of a draft restaurant food handler knowledge survey. The survey was modified based on comments provided by stakeholders. March 2009- IRB approval of the final revised pre-intervention survey. April 2009- Survey
Research Lab conducted pilot interviews to ensure survey feasibility in the field and to test appropriate methods to approach restaurant managers. June 2009- Survey Research Laboratory and UIC student research assistants began interviewing food handlers. As of August 31, 2009 there were approximately 280 pre-intervention interviews completed. The pre-intervention interviews are projected to continue into March 2010, however with the current completion rate, interviewing may be completed up to 6 weeks ahead of schedule. September 2009- IRB Continuing Review approval was obtained. October 2009- Survey Research Laboratory plans to begin data entry of the completed surveys. PARTICIPANTS: Key personnel have been added to this project. Mindi Manes, PhD Epidemiology candidate is acting as the research study coordinator. Palak Panchal, MPH and PhD candidate and Suzanne Brown, MPH candidate are
current research assistants. In accordance with the Research Protocol, staff from the Survey Research Laboratory at the University of Illinois at Chicago, with the assistance of the research assistants, are currently preforming the pre-intervention surveys. TARGET AUDIENCES: Nothing significant to report during this reporting period. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.