‘I got to publish a paper with Ninja in title’: evaluation of a food safety education game

Erstwhile food safety nerd and friend of the blog, Don Schaffner of Rutgers, was one of the authors of a new paper in the British Food Journal exploring food safety education for middle school youths.

“Teaching people about food safety is easy, says Schaffner. “Getting them to really get it – especially when it’s busy – is hard. This game shows the balancing act that kitchen employees have to master to keep customers happy while still keeping food safe.  Plus I got to publish a paper with Ninja in the title.  How cool is that?”

The game is available at http://ninjakitchengame.org.

ninja.kitchenAbstract below.

Ninja Kitchen to the rescue: Evaluation of a food safety education game for middle school youth

British Food Journal, Vol. 115 Iss: 5, pp.686 – 699

Virginia Quick, Kirsten W. Corda, Barbara Chamberlin, Donald W. Schaffner, Carol Byrd-Bredbenner


Purpose – The purpose of this paper is to assess the effect of Ninja Kitchen, a food safety educational video game, on middle school students’ food safety knowledge, psychographic characteristics, and usual and intended behaviors.

Design/methodology/approach – The experimental group (n=903) completed the following activities about one week apart from each other: pretest, played the game, posttest, and follow-up test. The control group (n=365) completed the same activities at similar intervals but did not have access to the game until after the follow-up test.

Findings – Linear mixed-effects models, controlling for gender, grade, and geographic location revealed significant time by group effects for knowledge of safe cooking temperatures for animal proteins and danger zone hazard prevention, and usual produce washing behaviors. Pairwise comparisons, adjusted for multiple comparisons, indicated that after playing the game, the experimental group felt more susceptible to foodborne illness, had stronger attitudes toward the importance of handling food safely and handwashing, had greater confidence in their ability to practice safe food handling, and had greater intentions to practice handwashing and safe food handling. Teachers and students found the game highly acceptable.

Originality/value – The game has the potential to promote positive food safety behaviors among youth, in a fun and educational format.

Still lots of people getting sick; CDC says most foodborne illness rates remain static

Only Washington-types could take a story about recent successes and failures in foodborne illness rates and surveillance – 18 fascinating papers — and turn it into a whine about how lobbyists were excluded from access, ahead of mere mortals.

The Washington Post reports that unlike last year, the U.S. Centers for Disease Control released the data without reaching out to consumer groups and other key stakeholders who typically are notified in advance. Instead, the charts and graphs were quietly posted online Friday.

I’m not sure who these key stakeholders are, and how many of them are self-proclaimed. The solution is for CDC to publish a press release summarizing the findings, note their existence, and releasing it to everyone at the same time.

And only in Washington would people whine that delayed passage of the Food Safety Modernization Act is leading to increases in foodborne illness.

“Everyone was hoping that this new food safety law would be in place and we’d start seeing improvements by now,” said Erik Olson, a director at the Pew Health Group. “What these CDC numbers show is that unless new protections are put into place, millions of Americans are going to continue to get sick from contaminated food.”

I’m immediately suspicious of people who speak on behalf of everyone (and people who say trust me). I have yet to see a credible, detailed analysis that shows FSMA will lower rates of foodborne illness.

But that’s the bizness of Washington. They don’t seem good at it.

Four years ago, the CDC numbers yielded the same story – rates were stagnant, but still way too many sick people. There is no evidence educational campaigns do anything except make people feel like they are doing something, there is no evidence legislation does much, yet that’s always the punchline: we need more laws, we need more education.

Doesn’t work.

We need new messages using new media to really create a culture that values microbiologically safe food.

That’s what I said four years ago, it could have been 20 years ago. Same as it ever was.
The most recent figures from the Centers for Disease Control and Prevention show that the rates of infections linked to four out of five key pathogens it tracks — salmonella, vibrio, campylobacter and listeria — remained relatively steady or increased from 2007 through 2011. The exception is a strain of E. coli, which has been tied to fewer illnesses in the same time frame.

The CDC found that the most frequent cause of infection in 2011 was salmonella, followed by campylobacter.

Below are actual excerpts from the CDC summary report. All 18 abstracts will appear on bites-l as soon as I complete a long plane ride, custom(s) probing, and return to the land of unlimited Internet.

Foodborne disease is an important public health problem in the United States, with an estimated 9.4 million domestically acquired illnesses and 1351 deaths from known pathogens each year. The Foodborne Diseases Active Surveillance Network (FoodNet) tracks important foodborne illnesses, generating information that provides a foundation for food safety policy and prevention efforts. FoodNet has provided information that contributes to food safety efforts by estimating numbers of foodborne illnesses, monitoring trends in incidence of specific foodborne illnesses over time, attributing illnesses to specific foods and settings, and disseminating information. Since it started in 1996, FoodNet has been an excellent example of partnership among federal and state agencies. This Clinical Infectious Diseases supplement contains a variety of articles that provide new information on current issues; together, they highlight FoodNet’s central role in U.S. surveillance and investigation of foodborne disease.

FoodNet’s core work is ongoing active, population-based surveillance for laboratory-confirmed infections caused by 9 pathogens transmitted commonly through food, as well as for hemolytic uremic syndrome. Several articles in this supplement report on these core data, examining trends and providing regulatory and public health agencies, industry, and consumer groups with data needed to prioritize and evaluate food safety interventions and monitor progress toward national health objectives. For example, Ong et al report the dramatic decline in Yersinia enterocolitica infections since 1996, particularly among young black children. Not all the news is good, however; Newton et al [analyze data from FoodNet and the Cholera and Other Vibrio Illness Surveillance System (COVIS), showing that Vibrio infections have increased nationally. Two articles in this supplement examine FoodNet surveillance data on invasive listeriosis. The article by Silk et al summarizes trends in surveillance data from 2004 to 2009, whereas Pouillot et al use FoodNet surveillance data to estimate the relative risk of listeriosis by age, pregnancy, and ethnicity, providing new insights into variations in risk across the population. Together, these articles emphasize that to substantially decrease the incidence of listeriosis, prevention measures should target higher-risk groups, particularly pregnant women, especially Hispanics, and older adults. Hall et al examine trends in Cyclospora infection, showing that outbreaks and international travel play an unusually large role in the epidemiology of these infections and suggesting that prevention efforts would most effectively focus on foods from and travel to endemic areas.

FoodNet continuously works to improve the quality of its surveillance data and methods for analysis. In this supplement, Henao et al describe the methods and rationale surrounding the introduction, in 2011, of a measure of overall change in the incidence of infection over time using surveillance data on infections caused by 6 bacterial pathogens. This measure, which provides a comprehensive picture of changes in incidence of foodborne infections, documents a 23% decline overall in incidence for these pathogens in 2010 compared with the first 3 years of surveillance (1996–1998). Although it does not replace pathogen-specific trend data, this summary measure can help inform the development and assessment of policies and interventions to prevent foodborne illness. Another article, by Manikonda et al, reports on a study to validate the reporting of deaths in FoodNet surveillance, an important issue because deaths, although rare, are disproportionately responsible for the economic and human costs of foodborne disease. Finally, Ong et al examine the impact of case ascertainment strategies and case definitions on surveillance for pediatric hemolytic uremic syndrome in FoodNet.

Several articles in the supplement elucidate aspects of the “surveillance steps” that are necessary for a case of infection to be ascertained by FoodNet surveillance. FoodNet and many other surveillance systems for bacterial enteric infections are based on culture-confirmed infections, so FoodNet surveillance data must be interpreted in the context of the “surveillance steps” that lead to culture confirmation: the ill person must seek medical care, a stool specimen must be submitted, and the clinical laboratory must test for and identify the pathogen. In particular, the recent and ongoing shift among clinical laboratories toward culture-independent methods for detecting enteric pathogens is of great importance.

In 2011, the CDC released new estimates of the number of foodborne illnesses in the United States, the Food Safety Modernization Act was signed into law, and new national health objectives for foodborne illness were set as part of the Healthy People 2020 goals. All of these initiatives, as well as continued concern about food safety on the part of the public and policy makers, emphasize the need for precise and accurate information about foodborne disease. Regulators and other public health officials, consumer advocates, industry, and others need information on trends, high-risk populations, and the foods causing illness so that interventions can be targeted most efficiently and effectively. FoodNet provides the articles in this supplement as part of its efforts to disseminate the results of its surveillance and analytic work. Although FoodNet surveillance is conducted in a geographic area that covers only 15% of the US population, the data it generates are a valuable resource for the entire United States. The FoodNet program shows the impact that high-quality, nationally coordinated surveillance can have on public health and policy.

Self-reported food safety surveys still suck, especially web ones, IFIC 2006-2010

Consumer attitudes toward food safety and their food-handling practices help to determine their risk of foodborne illness. The food safety questions in the International Food Information Council (IFIC) Foundation Food and Health Survey have tracked these attitudes and self-reported practices using an annual, web-delivered survey each year since 2006, with more extensive food safety questions starting in 2008.

Participants were members of an online panel compensated with a point system by a survey company, were recruited annually, and reflected the latest Census data for the United States population on key Census characteristics, including age, gender, race, and level of educational attainment. Each year’s Survey included approximately 1,000 participants.

From 2008 to 2010, when the Survey included detailed food safety questions, participant confidence in the food supply increased (P = .000) and respondent reports of the following key food safety practices — hand washing (P = .001), washing cutting boards (P = .000), separating raw meat and poultry from ready-to-eat food products (P = .000), cooking to required temperature (P = .001), and properly storing leftovers (P = .000) — as well as following microwave cooking instructions declined (P ≤ .001).

White, more highly educated respondents, and respondents from households that included individuals who were particularly vulnerable to foodborne illness, were more likely to report following recommended food safety practices. Survey respondents reported using expiration dates (68%), ingredient listings (54%), allergen labeling (9%), organic labeling (16%), and country of origin labeling (16%) on package labels to make food purchase and consumption decisions.

Consumers used a range of sources for food safety information. The most trusted sources were government agencies/officials (39%), health professionals (37%), health associations (31%) and television news programs (31%).

Consumer responses show gaps in knowledge and implementation of food safety behaviors that can be addressed by food safety educators, and demographic differences documented by survey responses can help educators put their information into contexts that will make it more compelling. Food safety information needs to have consistent, actionable messages distributed through multiple delivery systems to reach target audiences.

International food information council foundation food and health survey, 2006–2010, food safety: a web-enabled survey
Food Protection Trends, Vol. 32, No. 6, Pages 309–326
Mildred M. Cody, Robert Gravani, Marianne Smith Edge, Carrie Dooher
and Christy White

Daily Show does pink slime; skewers industry and government communication efforts

Political fodder is comedic gold.

Satirists, like others, also eat.

Jon Stewart loves cheeseburgers.

The ingredients of public outrage over pink slime melded like a savory stew last night on the Daily Show to produce a potpourri of insights on how not to chat with people who eat.

And it was so easy because the politicians and industry seem so hapless.

U.S. Secretary of Agriculture Tom Vilsack and Iowa Governor Terry Branstad held a press conference in Des Moines Wednesday afternoon to address concerns and educate the public about the processing of lean, finely textured beef, or LFTB.

"That’s why we’re going to have people from Iowa State University and Texas A&M and knowledgeable people from USDA (U.S. Department of Agriculture) counter the smear and counter the misinformation with the facts," said Iowa Gov. Terry Branstad.

Facts are never enough. Otherwise rBST would be routinely used in dairy production, genetically-engineered foods would be flaunted not shunned, and irradiation would make pink slime redundant.

Science is never enough in the public arena.

Vilsack, a former Iowa governor, said education is especially important when a growing number of people are increasingly farther removed from agriculture.

"The reality is a very small percentage of America’s population produces 85% to 90% of what we consume.”

I’m not sure what being a beef farmer has to do with meat processing that involves centrifuges.

Stewart reasoned, "any food can be disgusting if you take its ingredients out of context." Perhaps the same thing was true of pink slime burgers?

Stewart cut to an animated news report that explained the process for making pink slime: Waste trimmings are gathered, simmered at low heat to make it easier to separate fat from muscle, then put into a centrifuge, sprayed with ammonia gas to kill bacteria, compressed into bricks, flash-frozen and finally shipped to grocery stores nationwide, where it’s added to ground beef. Yummy!

He also expressed his admiration for the beef industry’s preferred nomenclature, "lean, finely textured beef." "It makes it sound like something rich beef-eaters can buy from Hammacher Schlemmer," Stewart said. "It’s the cashmere of beef."

Stewart also marveled at the irony of pink slime: "McDonald’s doesn’t think it’s an appropriate thing to eat? These are the people who molded a pork disc into a rib-shaped sandwich … that contains no ribs. Nobody knows how they did it! But this stuff, pink slime? That’s too fake for McDonald’s?"

I can provide references for everything I say – that educating people is about the worst communications strategy because it invalidates and trivializes people’s thoughts. But that stuff is boring.

Stewart says the same thing but in a way that is much more entertaining.

Whenever a group says the public needs to be educated about food safety, biotechnology, trans fats, organics or anything else, that group has utterly failed to present a compelling case for their cause. Individuals can choose to educate themselves about all sorts of interesting things, but the idea of educating someone is doomed to failure. And it’s sorta arrogant to state that others need to be educated; to imply that if only you understood the world as I understand the world, we would agree and dissent would be minimized.

Or as Stewart said, “You got rid of it because we found out it was pink slime.”

Proponents of pink slime or any other technology shouldn’t expect consumers to roll over and accept it. They need to promote, brag and saturate microbial food safety claims in the marketplace. Otherwise, any farmer, processor or restaurant can be held hostage by a mere accusation – regardless of the science.

Shoppers will support honest information, instead of being told they have to become better educated about someone else’s limited perspective.

The Daily Show segment is available for U.S. viewers at http://www.thedailyshow.com/watch/wed-march-28-2012/march-28–2012—pt–2.

96 sick, mainly little kids; multistate outbreak of Salmonella Altona and Johannesburg infections linked to chicks and ducklings from a mail-order hatchery — United States, February–October 2011

I worry about this every time my daughter’s school brings in chicks and other animals. And I always make sure to ask if they are testing for salmonella and what kind of controls are in place. And I complain about parents parking in the handicapped spots. They think I’m crazy, but I’ll show them. Except no one wins with salmonella either.

The U.S. Centers for Disease Control is reporting that salmonella infections from contact with live poultry (chickens, ducks, turkeys, and geese) continue to be a public health problem.

In summer 2011, two clusters of human Salmonella infections were identified through PulseNet, a molecular subtyping network for foodborne disease surveillance. Standard outbreak and traceback investigations were conducted. From February 25 to October 10, 2011, a cluster of 68 cases caused by Salmonella serotype Altona and a cluster of 28 cases caused by Salmonella Johannesburg were identified in 24 states. Among persons infected, 32% of those with Salmonella Altona and 75% of those with Salmonella Johannesburg were aged ≤5 years. Forty-two of 57 (74%) Salmonella Altona patients and 17 of 24 (71%) of Salmonella Johannesburg patients had contact with live poultry in the week preceding illness. Most patients or their parents reported purchasing chicks or ducklings from multiple locations of an agricultural feed store chain that was supplied by a single mail-order hatchery. Live poultry were purchased for either backyard flocks or as pets.

Live poultry are commonly purchased from agricultural feed stores or directly from mail-order hatcheries; approximately 50 million chicks are sold annually in the United States. Since 1990, approximately 35 outbreaks of human Salmonella infections linked to contact with live poultry from mail-order hatcheries have been reported. These outbreaks highlight the ongoing risk for human Salmonella infections associated with live poultry contact, especially for young children.

In response to this ongoing public health problem, officials with local, state, and federal public and animal health agencies, the U.S. Department of Agriculture’s National Poultry Improvement Plan (USDA-NPIP), the mail-order hatchery industry, and other partners have collaborated to develop and implement a comprehensive Salmonella control strategy. Mail-order hatcheries should comply with management and sanitation practices outlined in the USDA-NPIP Salmonellaguidelines and should avoid the shipment of hatched chicks between multiple hatcheries before shipping to customers. Educational materials warning customers of the risk for Salmonella infection from live poultry contact are available and should be distributed with all live poultry purchases.

Colorado farmers urged to lead in food safety after listeria outbreak

Larry “Larry” Goodridge (right, exactly as shown) got it right when he said farmers bear primary responsibility for food safety and they shouldn’t rely on third-party audits, but should retroactively fail my risk analysis course for saying Colorado’s response to the listeria-in-cantaloupe outbreak that killed 36 people "was as close to perfect as we are going to see" and that "Our food supply is one of the safest in the world, if not the safest."

Goodridge, an associate professor of food microbiology at Colorado State University, did follow up by telling the Governor’s Forum on Colorado Agriculture yesterday, “But if you were to ask that question of family members who had someone die, they would tell you our food supply is not safe." Lots of people would say the food supply is not safe. Maybe about 48 million of them. Best to keep meaningless rankings out of the equation.

He also said the state could improve by creating a team that activated within hours of an outbreak, and that the government should target spending on high-risk produce — in particular, by educating farmers who grow high-risk produce. More focus on food inspectors isn’t likely to significantly improve the system. Larry urged farmers to focus on sanitary practices such as keeping equipment and storage areas clean. He also urged them to educate the public on ways to safely handle produce in the same manner as consumers are advised how to safely handle meat.

As usual, no details were provided on how best to do this so-called education, for farmers or consumers.

Farm Fresh Direct chief executive Jim Knutzon, said he expects the federal government will write more specific regulations for growing cantaloupe and other produce. Then third-party auditors — hired by farms to inspect their operations — will have to check for specific standards called for by the Food and Drug Administration.

Food allergies linked to hygiene hypothesis? ‘If fewer allergies is more infection, no parent would expose their child to more infection’

People from well-educated families are almost twice as likely to suffer from some dangerous food allergies as others — possibly because their bodies’ natural defences have been lowered by rigorous hygiene and infection control, suggests a new Canadian study.

The research from McGill University also found that immigrants were about half as likely to be afflicted by the allergies, perhaps reflecting differences in diet and environment between their countries of origin and Canada.

The study, just published in the Journal of Allergy, was meant to address an enduring medical mystery: Why have so many people in certain industrialized countries developed violent reactions to peanuts, shellfish and other foods in recent decades?

The link to higher education may be explained by what is called the hygiene hypothesis, the unproven idea that smaller families, cleaner homes, more use of antibiotics to treat infections and vaccines to prevent them have curbed development of the immune system, said Dr. Moshe Ben-Shoshan, who led the research. That in turn could make some people more susceptible to allergy.

If the hypothesis does actually explain some food reactions, though, parents may not be able to do much about it, admitted the allergist at Montreal Children’s Hospital. The benefits of such health products as antibiotics and vaccines easily outweigh the risk of children developing serious allergies, said Dr. Ben-Shoshan.
“We can’t suggest we become dirtier and expose our children to more bacteria,” he said. “If the price of having fewer allergies is more infection, I don’t know any parent who would expose their child to more infection.”

The study’s findings are far from conclusive but they, and the hygiene hypothesis as an explanation, seem plausible, said Dr. Stuart Carr, president of the Canadian Society of Allergy and Clinical Immunology. He also cautioned, however, that translating the knowledge into preventive action would be complicated.

We don’t need no education: burger preparation, what consumers say and do in the home

I cringe when someone says, ‘food safety is simple.’

A review of existing studies by the U.K. Food Standards Agency found that, although people “are often aware of good food hygiene practices, many people are failing to chill foods properly, aren’t following advice on food labels and aren’t sticking to simple hygiene practices that would help them avoid spreading harmful bacteria around their kitchens.”

Yes, individuals are impervious to risk; been known for decades.

And there’s that word, ‘simple’ again.

I especially cringe when someone says, ‘cooking a hamburger is easy with these simple food safety steps.’

Ho Phang and Christine Bruhn report in the current Journal of Food Protection that in video observation of 199 California consumers making hamburgers and salad in their own kitchens, handwashing was poor, only 4% used a thermometer to check if the burger was safely cooked, and there were an average of 43 cross-contamination events per household.

There’s some good data in the paper about what consumers do in their own kitchens, and the results are an additional nail in the self-reported-food-safety-survey coffin: people know what they are supposed to do but don’t do it.

But what the paper doesn’t address is how to influence food safety behaviors. Instead, the University of California at Davis authors fall back on the people-need-to-be-educated model, without out providing data on how that education – I prefer compelling information – should be provided.

The authors state:

• educational materials need to emphasize the important role of the consumer in
preventing foodborne illness and that foodborne illnesses can result from foods prepared in the home.;

• the gap between the awareness of the importance of hand washing and the actual practice of adequate hand washing should be addressed by food safety educators.

• food safety educators should address the lack of reliability of visual cues during cooking (stick it in — dp);

• food safety educators should emphasize faucet cleaning with soap and water as a way of preventing cross-contamination; and,

• ignorance about food irradiation point to a further need for education.

The authors do correctly note that program to promote the use of thermometers when cooking burgers, initiated by the introduction of Thermy in 2000, has not been successful. So why do more education?

And the E. coli O157:H7 outbreak in Jack-in-the-Box hamburgers happened in Jan. 1993, not 1994 as stated in the paper; someone should have caught that.

Burger preparation: what consumers say and do in the home
Journal of Food Protection®, Volume 74, Number 10, October 2011 , pp. 1708-1716(9)
Phang, Ho S.; Bruhn, Christine M.
Ground beef has been linked to outbreaks of pathogenic bacteria like Escherichia coli O157:H7 and Salmonella. Consumers may be exposed to foodborne illness through unsafe preparation of ground beef. Video footage of 199 volunteers in Northern California preparing hamburgers and salad was analyzed for compliance with U.S. Department of Agriculture recommendations and for violations of the U.S. Food and Drug Administration’s Food Code 2009. A questionnaire about consumer attitudes and knowledge about food safety was administered after each filming session. The majority of volunteers, 78%, cooked their ground beef patties to the Food Code 2009 recommended internal temperature of 155°F (ca. 68°C) or above, and 70% cooked to the U.S. Department of Agriculture consumer end-point guideline of 160°F (ca. 71°C), with 22% declaring the burger done when the temperature was below 155°F. Volunteers checked burger doneness with a meat thermometer in 4% of households. Only 13% knew the recommended internal temperature for ground beef. The average hand washing time observed was 8 s; only 7% of the hand washing events met the recommended guideline of 20 s. Potential cross-contamination was common, with an average of 43 events noted per household. Hands were the most commonly observed vehicle of potential cross-contamination. Analysis of food handling behaviors indicates that consumers with and without food safety training exposed themselves to potential foodborne illness even while under video observation. Behaviors that should be targeted by food safety educators are identified.

Stop blaming consumers: be the bug, food safety is farm-to-fork

It’s the first day of spring in Australia, which means daughter Courtlynn is heading back to the Northern Hemisphere to start school, the temperature is soaring, and an entire month awaits of unverified, repetitious and banal food safety messages aimed at consumers.

The Brits got an early start about a week ago.

The Food Standards Agency published a review of existing studies that explore how people manage food safety in their homes.

The report found that, although they are often aware of good food hygiene practices, many people are failing to chill foods properly, aren’t following advice on food labels and aren’t sticking to simple hygiene practices that would help them avoid spreading harmful bacteria around their kitchens. People often know what they should be doing, but they don’t put this knowledge into practice, believing they are not vulnerable to food poisoning.

Yes, individuals are impervious to risk; been known for decades.

There’s oodles of material to pick through in the full report, but my favorite is this: people have a low level of awareness of recommended good practice with respect to cooking (correct final cooked temperature).

Maybe FSA should stop telling people to cook things until they are ‘piping hot.’

Food safety isn’t just a consumer thing – it’s an everybody thing. Forget the farm groups and industries that fund the blame-consumers approach. What did consumers have to do with outbreaks involving peanut butter, pizza, pot pies, pet food, pepper and produce (washing don’t do much). That’s just the Ps.

Reciting prescriptive instructions – cook, clean, chill, separate – like some fascist country line dancing instructor benefits no one. Food safety is complex, and it takes effort.

Does moral education make food safer? China says yes; food is worse than twitter weiners

Maybe I’m losing something in translation, but Xinhua reports that experts in China have called for strengthening moral education to ensure food safety following a string of scandals in recent months.

Zhao Chenggen, an expert at the School of Government at Peking University, said on Wednesday that to promote moral education is conducive to urging food producers to place a higher value on public health.

Under the influence of moral cultivation, food producers could enhance their subjective consciousness to resist ill-gotten gains through adding toxic materials into food, he said.

"Moral decline in the food industry is more terrible than that in social communications," said another expert, Xu Yaotong, a professor of political science at the National School of Administration.

Premier Wen Jiabao said, "A country without the improved quality of its people and the power of morality will never grow into a mighty and respected power.”

Wen said that advancing the moral and cultural construction would help safeguard normal production, life and social order, as well as to eradicate the stain of swindling, corruption and other illegal conduct.