Toward Improving Food Safety in the Domestic Environment: A Multi-Item Rasch Scale for the Measurement of the Safety Efficacy of Domestic Food-Handling Practices

To reduce consumer health risks from foodborne diseases that result from improper domestic food handling, consumers need to know how to safely handle food. To realize improvements in public health, it is necessary to develop interventions that match the needs of individual consumers. Successful intervention strategies are therefore contingent on identifying not only the practices that are important for consumer protection, but also barriers that prevent consumers from responding to these interventions. A measure of food safety behavior is needed to assess the effectiveness of different intervention strategies across different groups of consumers. A nationally representative survey was conducted in the Netherlands to determine which practices are likely conducted by which consumers. Participants reported their behaviors with respect to 55 different food-handling practices. The Rasch modeling technique was used to determine a general measure for the likelihood of an average consumer performing each food-handling behavior. Simultaneously, an average performance measure was estimated for each consumer. These two measures can be combined to predict the likelihood that an individual consumer engages in a specific food-handling behavior. A single "food safety" dimension was shown to underlie all items. Some potentially safe practices (e.g., use of meat thermometers) were reported as very difficult, while other safe practices were conducted by respondents more frequently (e.g., washing of fresh fruit and vegetables). A cluster analysis was applied to the resulting data set, and five segments of consumers were identified. Different behaviors may have different effects on microbial growth in food, and thus have different consequences for human health. Once the microbial relevance of the different consumer behaviors has been confirmed by experiments and modeling, the scale developed in the research reported here can be used to develop risk communication targeted to the needs of different consumer groups, as well as to measure the efficacy of different interventions.     

A Model of Hygiene Practices and Consumption Patterns in the Consumer Phase

A mathematical model is presented, which addresses individual hygiene practices during food preparation and consumption patterns in private homes. Further, the model links food preparers and consumers based on their relationship to household types. For different age and gender groups, the model estimates (i) the probability of ingesting a meal where precautions have not been taken to avoid the transfer of microorganisms from raw food to final meal (a risk meal), exemplified by the event that the cutting board was not washed during food preparation, and (ii) the probability of ingesting a risk meal in a private home, where chicken was the prepared food item (a chicken risk meal). Chicken was included in the model, as chickens are believed to be the major source of human exposure to the foodborne pathogen Campylobacter. Monte Carlo simulations showed that the probability of ingesting a risk meal was highest for young males (aged 18-29 years) and lowest for the elderly above 60 years of age. Children aged 0-4 years had a higher probability of ingesting a risk meal than children aged 5-17 years. This difference between age and gender groups was ascribed to the variations in the hygiene levels of food preparers. By including the probability of ingesting a chicken meal at home, simulations revealed that all age groups, except the group above 60 years of age, had approximately the same probability of ingesting a chicken risk meal, the probability of females being slightly higher than that of males. The simulated results show that the probability of ingesting a chicken risk meal at home does not only depend on the hygiene practices of the persons preparing the food, but also on the consumption patterns of consumers, and the relationship between people preparing and ingesting food. This finding supports the need of including information on consumer behavior and preparation hygiene in the consumer phase of exposure assessments.     

Cooking Practices in the Kitchen—Observed Versus Predicted Behavior

Cross-contamination and undercooking are major factors responsible for campylobacteriosis and as such should be incorporated in microbiological risk assessment. A previous paper by van Asselt et al. ^{( 1 )} quantified cross-contamination routes from chicken breast fillet via hand, cutting board, and knife ending up in a prepared chicken-curry salad in the domestic kitchen. The aim of the current article was to validate the obtained transfer rates with consumer data obtained by video observations and microbial analyses of a home prepared chicken-curry salad. Results showed a wide range of microbial contamination levels in the final salad, caused by various cross-contamination practices and heating times varying from 2'44 to 41'30. Model predictions indicated that cooking times should be at least 8 minutes and cutting boards need to be changed after cutting raw chicken in order to obtain safe bacterial levels in the final salad. The model predicted around 75% of the variance in cross-contamination behavior. Accuracy of the model can further be improved by including other cross-contamination routes besides hands, cutting boards, and knives. The model proved to be fail-safe, which implies it can be used as a worst-case estimate to assess the importance of cross-contamination in the home.     

Improving Food Safety in the Domestic Environment: The Need for a Transdisciplinary Approach

Microbial food safety has been the focus of research across various disciplines within the risk analysis community. Natural scientists involved in food microbiology and related disciplines work on the identification of health hazards, and the detection of pathogenic microorganisms. To perform risk assessment, research activities are increasingly focused on the quantification of microbial contamination of food products at various stages in the food chain, and modeling the impact of this contamination on human health. Social scientists conduct research into how consumers perceive food risks, and how best to develop effective risk communication with consumers in order to improve public health through improved food handling practices. The two approaches converge at the end of the food chain, where the activities regarding food preparation and food consumption are considered. Both natural and social sciences may benefit from input and expertise from the perspective of the alternative discipline, although, to date, the integration of social and natural sciences has been somewhat limited. This article therefore explores the potential of a transdisciplinary approach to food risk analysis in terms of delivering additional improvements to public health. Developing knowledge arising from research in both the natural and social sciences, we present a novel framework involving the integration of the two approaches that might provide the most effective way to improve the consumer health associated with food-borne illness.     

Food Safety in the Domestic Environment: The Effect of Consumer Risk Information on Human Disease Risks

The improvement of food safety in the domestic environment requires a transdisciplinary approach, involving interaction between both the social and natural sciences. This approach is applied in a study on risks associated with Campylobacter on broiler meat. First, some web-based information interventions were designed and tested on participant motivation and intentions to cook more safely. Based on these self-reported measures, the intervention supported by the emotion "disgust" was selected as the most promising information intervention. Its effect on microbial cross-contamination was tested by recruiting a set of participants who prepared a salad with chicken breast fillet carrying a known amount of tracer bacteria. The amount of tracer that could be recovered from the salad revealed the transfer and survival of Campylobacter and was used as a measure of hygiene. This was introduced into an existing risk model on Campylobacter in the Netherlands to assess the effect of the information intervention both at the level of exposure and the level of human disease risk. We showed that the information intervention supported by the emotion "disgust" alone had no measurable effect on the health risk. However, when a behavioral cue was embedded within the instruction for the salad preparation, the risk decreased sharply. It is shown that a transdisciplinary approach, involving research on risk perception, microbiology, and risk assessment, is successful in evaluating the efficacy of an information intervention in terms of human health risks. The approach offers a novel tool for science-based risk management in the area of food safety.     

Communicating Fish Consumption Advisories in California: What Works,What Doesn’t

State agencies face many challenges in creating sport fish consumption advisories that can be readily understood by diverse populations. In this study, our objectives were to identify barriers to understanding consumption advisories and recommend more effective approaches for communicating advisory concepts. We conducted key informant interviews with demographically diverse consumers of sport fish from the Sacramento‐San Joaquin Delta watershed in California to explore how intended audiences perceive consumption advisories and identify factors that influence comprehension. Some barriers to communication included the use of portion sizes that departed from commonly consumed amounts, poorly understood terminology, misleading category headings, and ineffective visual tools. Comprehension was enhanced when advisory information did not contradict existing beliefs about fish or fish consumption, and when advisories provided information about contaminant levels in specific kinds of fish. Using certain methods, such as portion sizes that reflect commonly consumed amounts, mercury meters to convey contaminant levels, three advice categories (e.g., high, medium, low), and population definitions that identify specific age ranges, improved the clarity of advisory concepts for intended audiences.     

Public Perceptions of the Potential Hazards Associated with Food Production and Food Consumption: An Empirical Study

Although public perceptions of food-related hazards receive much media comment and debate, the research literature on such perceptions is sparse and piecemeal. In the reported study, 216 people completed a questionnaire relating to their perceptions of the "risk characteristics" of potential hazards associated with various aspects of food production and food consumption. Responses were examined via principal-components analysis to obtain a structural representation of risk perception of the kind provided by Fischhoff, Slovic, and their colleagues in their seminal psychometric work.^(1,2) A three-component solution accounting for 87% of the variance was obtained, with the dimensions labeled as "severity,""unknown," and "number of people exposed." The findings also yielded information pointing to evidence of the phenomenon of unrealistic optimism. We conclude that our findings offer a useful base upon which further in-depth research integrating different perspectives on risk perception with respect to food-related hazards may be developed.     

Predicting Vaccination Intention and Benefit and Risk Perceptions: The Incorporation of Affect,Trust, and Television Influence in a Dual‐Mode Model

Major health behavior change models tend to consider health decisions as primarily resulting from a systematic appraisal of relevant beliefs, such as the perceived benefits and risks of a pharmacological intervention. Drawing on research from the disciplines of risk management, communication, and psychology, this study proposed the inclusion of a heuristic route in established theory and tested the direction of influence between heuristic and systematic process variables. Affect and social trust were included as key heuristics in the proposed dual‐mode framework of health decision making. Furthermore, exposure to health‐related coverage on television was considered potentially influential over both heuristic and systematic process variables. To test this framework, data were collected from a national probability sample of 584 adults in the United States in 2012 regarding their decision to vaccinate against a hypothetical avian flu. The results provided some support for the bidirectional influence between heuristic and systematic processing. Affect toward flu vaccination and trust in the Food and Drug Administration were found to be powerful predictors of vaccination intention, enhancing intention both directly and indirectly via certain systematic process variables. The direction of influence between perceived susceptibility and severity, on the one hand, and affect, on the other, is less clear, suggesting the need for further research. Contrary to the opinion of media critics, exposure to televised health coverage was negatively associated with the perceived risks of vaccination. Results from this study carry theoretical and practical implications, and applying this model to the acceptance of different health interventions constitutes an area for future inquiries.     

Roy’s Safety‐First Portfolio Principle in Financial Risk Management of Disastrous Events

Roy pioneers the concept and practice of risk management of disastrous events via his safety‐first principle for portfolio selection. More specifically, his safety‐first principle advocates an optimal portfolio strategy generated from minimizing the disaster probability, while subject to the budget constraint and the mean constraint that the expected final wealth is not less than a preselected disaster level. This article studies the dynamic safety‐first principle in continuous time and its application in asset and liability management. We reveal that the distortion resulting from dropping the mean constraint, as a common practice to approximate the original Roy’s setting, either leads to a trivial case or changes the problem nature completely to a target‐reaching problem, which produces a highly leveraged trading strategy. Recognizing the ill‐posed nature of the corresponding Lagrangian method when retaining the mean constraint, we invoke a wisdom observed from a limited funding‐level regulation of pension funds and modify the original safety‐first formulation accordingly by imposing an upper bound on the funding level. This model revision enables us to solve completely the safety‐first asset‐liability problem by a martingale approach and to derive an optimal policy that follows faithfully the spirit of the safety‐first principle and demonstrates a prominent nature of fighting for the best and preventing disaster from happening.     

Growing Pains: How Risk Perception and Risk Communication Research Can Help to Manage the Challenges of Global Population Growth

In 2011, the global human population reached 7 billion and medium variant projections indicate that it will exceed 9 billion before 2045. Theoretical and empirical perspectives suggest that this growth could lead to an increase in the likelihood of adverse events (e.g., food shortages, climate change, etc.) and/or the severity of adverse events (e.g., famines, natural disasters, etc.). Several scholars have posited that the size to which the global population grows and the extent to which this growth increases the likelihood of adverse outcomes will largely be shaped by individuals’ decisions (in households, organizations, governments, etc.). In light of the strong relationship between perceived risk and decision behaviors, it is surprising that there remains a dearth of empirical research that specifically examines the perceived risks of population growth and how these perceptions might influence related decisions. In an attempt to motivate this important strand of research, this article examines the major risks that may be exacerbated by global population growth and draws upon empirical work concerning the perception and communication of risk to identify potential directions for future research. The article also considers how individuals might perceive both the risks and benefits of population growth and be helped to better understand and address the related issues. The answers to these questions could help humanity better manage the emerging consequences of its continuing success in increasing infant survival and adult longevity.     

The informed society: an analysis of the public's information-seeking behavior regarding coastal flood risks

Recent flood risk management puts an increasing emphasis on the public's risk perception and its preferences. It is now widely recognized that a better knowledge of the public's awareness and concern about risks is of vital importance to outline effective risk communication strategies. Models such as Risk Information Seeking and Processing address this evolution by considering the public's needs and its information-seeking behavior with regard to risk information. This study builds upon earlier information-seeking models and focuses on the empirical relationships between information-seeking behavior and the constructs of risk perception, perceived hazard knowledge, response efficacy, and information need in the context of coastal flood risks. Specific focus is given to the mediating role of information need in the model and to the differences in information-seeking behavior between permanent and temporary residents. By means of a structured on-line questionnaire, a cross-sectional survey was carried out in the city of Ostend, one of the most vulnerable places to coastal flooding on the Belgian coast. Three hundred thirteen respondents participated in the survey. Path analysis reveals that information need does not act as a mediator in contrast to risk perception and perceived knowledge. In addition, it is shown that risk perception and perceived hazard knowledge are higher for permanent than temporary residents, leading to increased information-seeking behavior among the former group. Implications for risk communication are discussed.     

Toward an Understanding of the Influence of Cultural Background and Domain Experience on the Effects of Risk‐Pricing Formats on Risk Perception

Risk‐information framing can be a powerful tool for aiding the communication of risk and improving decision making. However, little work has investigated the extent that these framing effects depend on the characteristics of the perceiver. In our study, we examine whether the effects of different risk‐pricing formats on risky choices are the same for all individuals, no matter their domain experience or cultural background, or whether there are interactions between these factors. Survey 1 revealed that three risk‐pricing formats of the same choice problem resulted in the same individuals making different risky choices (preference reversal), suggesting that risk perception was distorted by the risk‐pricing format manipulation. In Survey 2, the effects of the risk‐pricing formats were shown to differ by the participants’ cultural background (Asian vs. European) and the extent of their domain experience. The fact that there were no differences between the cultural or domain experience groups in their overall tendency to select riskier (cf. safer) choices indicates that risk behavior differences between groups are often closely linked to perceptual, rather than simply attitudinal, cognitive processes. The results demonstrate the complex, interactive cognitive processes that are used to encode risk information, involving the framing of the information and the cultural background and previous experiences of the individual. We conclude that it is important to consider the characteristics of the individual (e.g., culture, domain experience, etc.) when manipulating risk‐information framing with the aim of improving risk communication.     

Trust in Risk Management: A Model‐Based Review of Empirical Research

This review of studies of trust in risk management was designed, in part, to examine the relations between the reviewed research and the consensus model of trust that has recently emerged in other fields of study. The review begins by briefly elaborating the consensus views on the dimensionality and function of trust. It then describes the various models of trust that have been developed in the field of risk management, comparing them with the consensus approach. The findings of previous reviews are outlined, followed by a delineation of the open questions addressed by the present review, the method used, and the results. Finally, the findings of the review are discussed in relation to the important issue of trust asymmetry, the role of trust in risk management, and directions for future research. The consensus model specifies two conceptualizations of trust, each linked to particular types of antecedents. Relational trust, which is called trust in this review, is based on the relations between the trusting person and the other. Calculative trust, which is called confidence, is based on past behavior of the other and/or on constraints on future behavior. Results of this review showed that most studies of trust in risk management, while exploring matters of particular concern to the risk management community, were at least in part consistent with the consensus model. The review concludes by urging greater integration between the concerns of the former and the insights of the latter.     

Applying a Health Behavior Theory to Explore the Influence of Information and Experience on Arsenic Risk Representations, Policy Beliefs, and Protective Behavior

The common sense model (CSM) shows how people process information to construct representations, or mental models, that guide responses to health threats. We applied the CSM to understand how people responded to information about arsenic-contaminated well water. Constructs included external information (arsenic level and information use), experience (perceived water quality and arsenic-related health effects), representations, safety judgments, opinions about policies to mitigate environmental arsenic, and protective behavior. Of 649 surveys mailed to private well users with arsenic levels exceeding the maximum contaminant level, 545 (84%) were analyzed. Structural equation modeling quantified CSM relationships. Both external information and experience had substantial effects on behavior. Participants who identified a water problem were more likely to reduce exposure to arsenic. However, about 60% perceived good water quality and 60% safe water. Participants with higher arsenic levels selected higher personal safety thresholds and 20% reported a lower arsenic level than indicated by their well test. These beliefs would support judgments of safe water. A variety of psychological and contextual factors may explain judgments of safe water when information suggested otherwise. Information use had an indirect effect on policy beliefs through understanding environmental causes of arsenic. People need concrete information about environmental risk at both personal and environmental-systems levels to promote a comprehensive understanding and response. The CSM explained responses to arsenic information and may have application to other environmental risks.     

Food Safety in the Domestic Environment: An Interdisciplinary Investigation of Microbial Hazards During Food Preparation

It has been established that, to a considerable extent, the domestic hygiene practices adopted by consumers can result in a greater or lesser microbial load in prepared meals. In the research presented here, an interdisciplinary study is reported in which interviews, observations of consumers preparing a recipe, and microbial contamination of the finished meals were compared. The results suggest that, while most consumers are knowledgeable about the importance of cross-contamination and heating in preventing the occurrence of foodborne illness, this knowledge is not necessarily translated into behavior. The adoption of habitual cooking practices may also be important. Potentially risky behaviors were, indeed, observed in the domestic food preparation environment. Eighteen of the participants made errors in food preparation that could potentially result in cross-contamination, and seven participants allowed raw meat juices to come in contact with the final meal. Using a tracer microorganism the log reduction as a result of consumer preparation was estimated at an average of log 4.1 cfu/salad. When combining these findings, it was found that cross-contamination errors were a good predictor for log reduction. Procedural food safety knowledge (i.e., knowledge proffered after general open questions) was a better predictor of efficacious bacterial reduction than declarative food safety knowledge (i.e., knowledge proffered after formal questioning). This suggests that motivation to prepare safe food was a better indicator of actual behavior than knowledge about food safety per se.     

Bayesian Temporal Source Attribution of Foodborne Zoonoses: Campylobacter in Finland and Norway

Statistical source attribution approaches of food‐related zoonoses can generally be based on reported diagnosed human cases and surveillance results from different food sources or reservoirs of bacteria. The attribution model, or probabilistic classifier, can thus be based on the (sub)typing information enabling comparison between human infections and samples derived from source surveillance. Having time series of both data allows analyzing temporal patterns over time providing a repeated natural experiment. A Bayesian approach combining both sources of information over a long time series is presented in the case of Campylobacter in Finland and Norway. The full model is transparently presented and derived from the Bayes theorem. Previous statistical source attribution approaches are here advanced (1) by explicit modeling of the cases not associated with any of the sources under surveillance over time, (2) by modeling uncertain prevalence in a food source by bacteria type over time, and (3) by implementing formal model fit assessment using posterior predictive discrepancy functions. Large proportion of all campylobacteriosis can be attributed to broiler, but considerable uncertainty remains over time. The source attribution is inherently incomplete if only the sources under surveillance are included in the model. All statistical source attribution approaches should include a model fit assessment for judgment of model performance with respect to relevant quantities of interest. It is especially relevant when the model aims at a synthesis of several incomplete information sources under significant uncertainty of explanatory variables.     

Communicating Food Risks in an Era of Growing Public Distrust: Three Case Studies

The communication and regulation of risk has changed significantly over the past 30 years in Europe and to a noticeable but lesser extent in the United States. In Europe, this is partly due to a series of regulatory mishaps, ranging from mad cow disease in the United Kingdom to contamination of the blood supply in France. In the United States, general public confidence in the American government has been gradually declining for more than three decades, driven by a mix of cultural and political conflicts like negative political advertising, a corrosive news media, and cuts in regulatory budgets. While the former approach is based on an objective assessment of the risk, the latter is driven more by the perception of the risk, consumer sentiment, political will, and sectoral advocacy. In this article, the author examines three U.S.‐based food case studies (acrylamide, bisphenol A, and artificial food colorings) where regulations at the local and state levels are increasingly being based on perceived risk advocacy rather than on the most effective response to the risk, be it to food safety or public health, as defined by regulatory interpretation of existing data. In the final section, the author puts forward a series of recommendations for how U.S.‐based regulators can best handle those situations where the perceived risk is markedly different from the fact‐based risk, such as strengthening the communication departments of food regulatory agencies, training officials in risk communication, and working more proactively with neutral third‐party experts.     

Ethical Issues in Risk Communication: Continuing the Discussion

Proposed in this article is one possible framework for classifying multiple types of ethical issues in risk communication research and practice to help continue a discussion initiated in 1990 by Morgan and Lave. Some of the questions that each stage of the process for planning risk communication strategies appears to pose for ethics are discussed (e.g., selecting issues to be communicated, knowing the issue, dealing with constraints). Also discussed briefly are some issues raised by the possibility that risk communicators aspire to the status of a profession. The purpose is to foster discussion rather than issue a conclusive statement on the topic, because its very nature makes a definitive pronouncement indefensible.     

Source Credibility in Environmental Health – Risk Controversies: Application of Meyer's Credibility Index

This article applies an existing five-item index for measuring source credibility in the context of environmental health-risk controversy. Survey data were gathered in five upstate New York communities facing environmental health-risk issues. Analysis of the five case studies and a combined dataset (N = 870) show that the credibility index was consistently reliable across all applications. Use of the resulting index is demonstrated through a comparison of the credibility of the New York State Department of Health (active in each case), the industries associated with each case, and the newspaper providing coverage of each case. The credibility index was used to predict risk judgments in a structural equation model. Overall, the analysis demonstrated that the credibility index performed consistently well across the five cases and illuminated important differences in each. As such, the index should be a useful addition to many environmental health and risk communication studies.     

Trust‐Level Risk Evaluation and Risk Control Guidance in the NHS East of England

In recent years, the healthcare sector has adopted the use of operational risk assessment tools to help understand the systems issues that lead to patient safety incidents. But although these problem‐focused tools have improved the ability of healthcare organizations to identify hazards, they have not translated into measurable improvements in patient safety. One possible reason for this is a lack of support for the solution‐focused process of risk control. This article describes a content analysis of the risk management strategies, policies, and procedures at all acute (i.e., hospital), mental health, and ambulance trusts (health service organizations) in the East of England area of the British National Health Service. The primary goal was to determine what organizational‐level guidance exists to support risk control practice. A secondary goal was to examine the risk evaluation guidance provided by these trusts. With regard to risk control, we found an almost complete lack of useful guidance to promote good practice. With regard to risk evaluation, the trusts relied exclusively on risk matrices. A number of weaknesses were found in the use of this tool, especially related to the guidance for scoring an event's likelihood. We make a number of recommendations to address these concerns. The guidance assessed provides insufficient support for risk control and risk evaluation. This may present a significant barrier to the success of risk management approaches in improving patient safety.