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In spite of marked improvements noted in the incidence of illnesses from many foodborne pathogens, there remains a concern that the most vulnerable population groups continue to suffer foodborne illnesses disproportionately to the general population. The proposed studies focus on a highly vulnerable group, pregnant women. A research specific aim is proposed and one education, extension and outreach aim. Researchers from two state universities are collaborating: The Ohio State University (OSU) and Colorado State University (CSU). For the research aim, an evaluation study is conducted in year 1 to better understand the practices, behaviors and environment that might impact risk of foodborne illness. This is followed with an education program in years 2-3 to determine the impact of food safety education on reducing the risk of foodborne illness. Additionally, research findings will be communicated to consumers and health professionals in years 2-3 with a variety of outreach educational methods. Potential for exposure to Listeria monocytogenes or Salmonella spp. is the primary concern in these studies for the pregnant population.
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Specific Aim 1: Development, implementation and evaluation of a food safety education intervention among pregnant women. (Research Aim) Objective 1.1: Development of intervention phase (year 1). Objective 1.2: Educational intervention (years 1-3). Specific Aim 2: Formal and outreach education, publications. (Education, Extension and Outreach Aim) Objective 2.1: Revise, publish and disseminate the materials developed through this study to targeted audiences (year 3). Objective 2.2: Incorporate research findings into academic courses (year 3): Objective 2.3: Develop manuscripts for health professionals and educators that serve pregnant women and mothers of young infants (years 2-3).
NON-TECHNICAL SUMMARY: In spite of marked improvements noted in the incidence of illnesses from many foodborne pathogens, there remains a concern that the most vulnerable population groups continue to suffer foodborne illnesses disproportionately to the general population. The proposed studies focus on a highly vulnerable group, pregnant women. Potential for exposure to Listeria monocytogenes or Salmonella spp. is the primary concern in these studies for the pregnant population.
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APPROACH: Aim 1 focuses on English-and Spanish-speaking pregnant women from two income levels and will be completed in 3 phases. First, an educational curriculum in English and Spanish will be developed in year 1. Key informants will be utilized to determine acceptability of the curriculum to low-income English or Spanish-speaking pregnant women. Next, the pilot study of Aim 1 is designed to test the educational program with a small number of women from the target group to discover information not available in the literature necessary to conduct the educational program and to test the educational evaluation instruments. Finally, the research components of the educational program in Aim 1 are designed to test differences in accomplishments if education is delivered by low personal contact (control) or high personal contact with peer educators (treatment). Subjects will be randomly assigned to a treatment group. Effectiveness of the program will be evaluated with educational and microbiological outcomes. Food in the home (a ready-to-eat product and a home-prepared product) and the home environment (refrigerator and kitchen sink) will be tested for general sanitation (aerobic and coliform counts) and presence of foodborne pathogens (Listeria monocytogenes and Salmonella spp.). Aim 2 will be completed by all collaborating universities and will provide information to the target populations, clinical and health professionals, and graduate and undergraduate students. The expectation is that these studies will demonstrate the efficacy of educational interventions and the potential impact education can have on health outcome indicators.
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PROGRESS: 2007/09 TO 2008/09<BR>
OUTPUTS: The project is currently meeting Specific Aim 1. An 8-session education curriculum based on "Eating Smart, Being Active" was adapted for use with low-income English- and Spanish-speaking pregnant women (control curriculum). Five 30-minute lessons on food safety issues of importance during pregnancy were added to the curriculum to create the food safety enhanced (experimental) version. Both curriculums were piloted and implemented. A pre and post survey was designed by compilation of questions previously tested for validity and reliability with low-income English speaking women. The survey was evaluated with both target groups using the test, re-test method and adjustments made as needed. Data is currently being gathered and preliminary results analyzed using this survey. The expected outcomes to be measured are: improved food safety knowledge based on an intensive food safety curriculum, improved consumption and food handling behaviors, improved hygiene and decreased exposure to foodborne pathogens. This project is collaboration between Ohio State University and Colorado State University. <BR>PARTICIPANTS: Lydia C. Medeiros - Ohio State University Jeffrey LeJeune - Ohio State University Robert Scharff - Ohio State University John Sofos - Colorado State University Patricia Kendall - Colorado State University Susan Baker - Colorado State University <BR>TARGET AUDIENCES: English-speaking, low-income (185% of poverty), pregnant women Spanish-speaking, low-income (185% of poverty), pregnant women <BR><BR>
IMPACT: 2007/09 TO 2008/09<BR>
As of December 15, 2008, the combined number from the two states has resulted in 138 subjects, 42 in the control curriculum and 96 in the experimental curriculum. Of these 138 subjects, 61% were English speaking and 39% Spanish speaking. Preliminary results were analyzed using SPSS version 15. Analysis of variance was run with experimental group and language as main effects. According to preliminary results, greater increases in knowledge related to Salmonella (p<0.004) and Listeria (p<0.008) occurred in the experimental than control group. Improvement in food handling and general hygiene were measured using questions about dishcloth use and handwashing. Both showed a positive outcome (p<0.15, and p<0.0001), although language had the greater effect related to change, with the Spanish sample showing a greater change pre to post educational intervention. Outcomes related to improved food consumption are mixed. No changes occurred in consumption practices for hot dogs (Listeria), raw fruit or vegetable juices (Listeria and Salmonella), soft cheeses like Brie made with unpasteurized milk (Listeria) and raw milk (Listeria). However, many of the pre-survey results indicated participants were not consuming these items initially, leaving little room for improvement. Subjects did show improvement in food consumption behavior by a decrease in consumption of eggs with runny yolks (p<0.001), the main effect being the experimental group. There was also a decrease in raw cookie dough consumption (p<0.057), with a significant language main effect, with the English speaking sample showing a greater change. Consumption of homemade Mexican soft cheeses, like queso fresco, declined more among experimental than control subjects (p<0.019). This question also had a significant (p<0.0001) group by language interaction. Preliminary results are suggesting that intensive food safety education has an overall positive change in behaviors in pregnant women regarding food consumption, handling, and knowledge. Review of responses and comments provided to the program assistants by the subjects suggest that Latina women are willing to eat risky foods possibly based on long held beliefs about the food items.
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PROGRESS: 2006/09/15 TO 2007/09/14<BR>
OUTPUTS: In spite of marked improvements noted in the incidence of illnesses from many foodborne pathogens, there remains a concern that the most vulnerable population groups continue to suffer foodborne illnesses disproportionately to the general population. This study focuses on pregnant women, one of the highly vulnerable groups. Potential for exposure to Listeria monocytogenes or Salmonella spp. is the primary focus in an educational intervention design to improve consumer behavior as documented through educational and microbiological outcome assessment. The study focuses on low-income English and Spanish-speaking pregnant women in Pueblo, CO and metropolitan Columbus, OH. Both Specific Aims 1 and 2 were in process during this first year of the grant. Educational curriculum to be used in the pilot and intervention phases of the study has been revised to begin classes in November 2007. Marketing materials, educational assessment tools, and microbiological protocols have been developed and are to be tested for reliability, validity and effectiveness during the pilot phase (Nov 2007- Jan 2008). Materials to be seen by Spanish-speaking human subjects have been translated to Spanish and back-translated to English, as per requirements of the Institutional Review Board for human studies.. Community educators have been hired and trained to begin classes beginning Nov 2007. Study participants will be enrolled in the Expanded Food and Nutrition Education Program (EFNEP) for 8 weeks. Control group subjects will receive only the traditional EFNEP education intervention. Experimental group subjects will receive EFNEP education and an additional 5 lessons on food safety written by the research team specifically for pregnant women. Educational and in-home microbiological assessment will be completed pre and post educational intervention. The pilot phase will enroll 120 subjects (15 per group/per language/per state). Any revisions to curriculum or protocol will be completed prior to the intervention phase. The intervention phase will enroll 600 subjects (75 per group/per language/per state). <BR>PARTICIPANTS: Dr. Lydia Medeiros, extension specialist and food safety educator, The Ohio State University; Dr. Jeffrey LeJeune, extension specialist and microbiologist, The Ohio State University; Dr. Robert Scharff, statistics and experimental design, The Ohio State University; Dr. Patricia Kendall, extension specialist and food safety educator, Colorado State University; Dr. Susan Baker, EFNEP director, Colorado State University; Dr. John Sofos, food microbiologist, Colorado State University <BR>TARGET AUDIENCES: English- and Spanish-speaking low income pregnant women <BR>PROJECT MODIFICATIONS: The community educational program for the research program was modified to become the Expanded Food and Nutrition Education Program in Ohio and Colorado.