True life: Someone cares about our research (even the tabloids)

Katrina Levine, extension associate and lead author of Evaluating Food Safety Risk Messages in Popular Cookbooks writes,

If you have been following the discourse epic battle between Ben Chapman and Gwenyth Paltrow, you may be wondering why a celebrity wants anything to do with us.  Me too.

It all started a few years ago with a conversation about recipes and cooking, and just how little was said in recipes about handling food safely. I mean, “cook until done”? What does that even mean?

So with Chapman’s support, I set off on a mission – to look through recipes in cookbooks (29 books and over 1700 recipes) for evidence of safe food handling guidance – giving a safe internal temperatures and ways to avoid cross-contamination.

It took about a year to collect the data (remember, 1700+ recipes…), and another couple to finish the article, Evaluating Food Safety Risk Messages in Popular Cookbooks, just published in the British Food Journal.

Then the press release went out, and something notable happened. Someone, somewhere, decided it was worth sharing. So it got shared – and talked about – a lot.

And there was an opportunity here: Talking with the media and posting about our study has never been about bashing celebrities, but about a chance to get our messages out there while we are being listened to.

I’ve done a few interviews and while the journalists may want to talk about Gwyneth, and who was the worst, I get to interject stuff into the pop culture conversation like, use a thermometer; follow safe endpoint temperatures; and, keep your hands and food surfaces clean and sanitized.

This is a researcher’s dream – to have your work noticed, discussed, and sometimes understood – by lots of people.

Putting in the work was worth it because what we did got noticed. And people are talking about it. Maybe they’ll be changing what they do because of it.

I am living the dream.

Cookbooks Give Readers (Mostly) Bad Advice On Food Safety

Cookbooks could be a much better source of food safety information than they are. So could online recipes (like those from Epicurious, and

Katrina reminded me today that those are next.

The NC State University press release on our cookbook paper came out today.

For Immediate Release

March 27, 2017

A recent study finds that bestselling cookbooks offer readers little useful advice about reducing food-safety risks, and that much of the advice they do provide is inaccurate and not based on sound science.

“Cookbooks aren’t widely viewed as a primary source of food-safety information, but cookbook sales are strong and they’re intended to be instructional,” says Ben Chapman, senior author of a paper on the work and an associate professor of agricultural and human sciences at North Carolina State University.

“Cookbooks tell people how to cook, so we wanted to see if cookbooks were providing any food-safety information related to cooking meat, poultry, seafood or eggs, and whether they were telling people to cook in a way that could affect the risk of contracting foodborne illness,” Chapman says.

To that end, the researchers evaluated a total 1,497 recipes from 29 cookbooks that appeared on the New York Times best sellers list for food and diet books. All of the recipes included handling raw animal ingredients: meat, poultry, seafood or eggs.

Specifically, the researchers looked at three things:

Does the recipe tell readers to cook the dish to a specific internal temperature?
If it does include a temperature, is that temperature one that has been shown to be “safe”? For example, cooking chicken to 165°F.

Does the recipe perpetuate food-safety myths – such as saying to cook poultry until the juices “run clear” – that have been proven unreliable as ways of determining if the dish has reached a safe temperature?

The researchers found that only 123 recipes – 8 percent of those reviewed – mentioned cooking the dish to a specific temperature. And not all of the temperatures listed were high enough to reduce the risk of foodborne illness.

“In other words, very few recipes provided relevant food-safety information, and 34 of those 123 recipes gave readers information that wasn’t safe,” Chapman says. “Put another way, only 89 out of 1,497 recipes gave readers reliable information that they could use to reduce their risk of foodborne illness.”

In addition, 99.7 percent of recipes gave readers “subjective indicators” to determine when a dish was done cooking. And none of those indicators were reliable ways to tell if a dish was cooked to a safe temperature.

“The most common indicator was cooking time, which appeared in 44 percent of the recipes,” says Katrina Levine, lead author of the paper and an extension associate in NC State’s Department of Agricultural and Human Sciences. “And cooking time is particularly unreliable, because so many factors can affect how long it takes to cook something: the size of the dish being cooked, how cold it was before going into the oven, differences in cooking equipment, and so on.”

Other common indicators used in the cookbooks included references to the color or texture of the meat, as well as vague language such as “cook until done.”

“This is important because cooking meat, poultry, seafood and eggs to a safe internal temperature kills off pathogens that cause foodborne illness,” Levine says. “These temperatures were established based on extensive research, targeting the most likely pathogens found in each food.”

A list of safe cooking temperatures can be found here.

“Ideally, cookbooks can help us make food tasty and reduce our risk of getting sick, so we’d like to see recipes include good endpoint cooking temperatures,” Chapman says. “A similar study was done 25 years ago and found similar results – so nothing has changed in the past quarter century. But by talking about these new results, we’re hoping to encourage that change.”

The paper, “Evaluating food safety risk messages in popular cookbooks,” is published in British Food Journal. The paper was coauthored by Ashley Chaifetz, a former Ph.D. student in Chapman’s group at NC State who now works for the U.S. Department of Agriculture’s Food and Nutrition Service. The work was supported by USDA’s National Institute of Food and Agriculture under grant number 2012-68003-30155.

Note to Editors: The study abstract follows.

“Evaluating food safety risk messages in popular cookbooks”

Authors: Katrina Levine and Benjamin Chapman, North Carolina State University; Ashley Chaifetz, U.S. Department of Agriculture

Published: March 17, British Food Journal

DOI: 10.1108/BFJ-02-2017-0066


Purpose: Medeiros et al. (2001) estimate 3.5 million cases of foodborne illness in the U.S. annually are associated with inadequate cooking of animal foods or cross-contamination from these foods. Past research shows home food handling practices can be risk factors for foodborne illness. The purpose of this study was to evaluate the communication of food safety guidance, specifically safe endpoint temperatures and cross-contamination risk reduction practices, in popular cookbook recipes.

Design/methodology/approach: Recipes containing raw animal ingredients in 29 popular cookbooks were evaluated through content analysis for messages related to safe endpoint temperature recommendations and reducing cross-contamination risks.

Findings: Of 1,749 recipes meeting study criteria of cooking raw animal ingredients, 1,497 contained a raw animal that could effectively be measured with a digital thermometer. Only 123 (8.2%) of these recipes included an endpoint temperature, of which 89 (72.3%) gave a correct temperature. Neutral and positive food safety behavior messages were provided in just 7.2% (n=126) and 5.1% (n=90) of recipes, respectively. When endpoint temperatures were not included, authors often provided subjective and risky recommendations.

Research limitations/implications: Further research is needed on the effect of these results on consumer behavior and to develop interventions for writing recipes with better food safety guidance.

Practical implications: Including correct food safety guidance in cookbooks may increase the potential of reducing the risk of foodborne illness.

Originality/value: Popular cookbooks are an underutilized avenue for communicating safe food handling practices and currently cookbook authors are risk amplifiers.

Lost in translation? Dirty grills cause hep A and and you should wash your meat

Last week’s Consumer Food Safety Education Conference reminded me that even when folks (agencies, organizations, individuals) say that they are sharing evidence-based information with the masses, not everyone agrees on the science, or the message.

There will always be conflict (and that’s okay – harmonized messages look suspicious), what’s more important is that people share how they made their risk-based decisions.

And that’s not often done.x600

Like why does USDA suggest in their consumer messages that the danger zone for pathogen growth is between 40F and 140F, and FDA’s Model Food Code, which is well referenced says that the parameters are 41F and 135F?

ABS-CBN News story demonstrates that some folks in the Philippines are looking at different data related to risks.

According to microbiologist Dr. Windell Rivera, raw meat and poultry, the most common ingredients of grilled street food, can easily be contaminated by various bacteria.

According to Rivera, some cases could lead to Hepatitis A, or even kidney failure (the headline of the piece is ‘Cooking on unclean grills can cause Hepatitis-A’ – looking at the evidence in the literature, no it can’t -ben).

Rivera advised thorough washing of poultry and meat products using clean water prior to cooking, as not all bacteria can be killed by heat. Sauces must also be stored properly as they can be contaminated by bacteria if meat with saliva or microorganisms are dipped into them.

Experts added that when cooking and grilling, meat must be thoroughly cooked. Also, as much as possible, chicken must be separated from pork.

Washing meat prior to cooking is a bad idea. 

Where are my cantaloupes grown: how is non-food safety nerd to know?

I love cantaloupe. It’s probably my favorite fruit. We buy one every couple of weeks, wash the outside with a scrub brush, cut it up and keep it in the fridge (which I have set for 40F) for about 3 days (since Listeria grows, although slowly, at refrigeration temperatures, I started paying attention to how long we kept it after the 2011 Jensen Farms-linked outbreak).

On Friday, CDC announced the investigation into a cluster of salmonellosis illnesses tied to  Southern Indiana-grown cantaloupes.  Attached to that announcement was a list of consumer recommendations:

Consumers who recently purchased cantaloupes grown in southwestern Indiana are advised not to eat them and discard any remaining cantaloupe.

Based on the available information, consumers can continue to purchase and eat cantaloupes that did not originate in southwestern Indiana.

Many cantaloupes have the growing area identified with a sticker on the fruit. If no sticker is present, consumers should inquire about the source. When in doubt, throw it out.

Consumers who are buying or have recently bought cantaloupe should ask their retailer if the cantaloupe was grown in southwestern Indiana.

Yesterday, I was just a regular taking-my-kids-shopping patron of a grocery store. One that wanted some cantaloupe. I decided to do a bit of reality research (n=1) and follow the consumer recommendations from the perspective of a non-food safety nerd. I checked the sticker on one of the cantaloupes in the bin and it said:
"S&S Stamoules Produce, Product of USA" (right, exactly as shown).

Nothing about the region or anything. I tried to google the producer’s name to see where they were located – but I didn’t have cell coverage.I asked the kid stocking the produce section. He said he didn’t know.

So I left empty-handed.

I didn’t bother enquiring about the cantaloupe we purchased two weeks ago.

When I got home I went back to trusty Google and found that Stamoules Produce is located in California’s San Joaquin Valley (and has a food safety section on their website where they focus exclusively on pesticides – no mention of good ag practices or whether they clean and sanitize their production line). I’ll have to remember that next time.

Repeat: rapid repeated reliable relevant food safety messages; repeat

Florida has only a few restaurants with flawless inspection scores, and chefs who run them offer some tough advice: Hire outside inspectors, treat the ice machine as a potential felon and become fanatical about details that others overlook.

Mark Brown, executive chef of The Sanctuary Golf Club on Sanibel Island, one of just a half-dozen kitchens to earn perfect inspection scores this past autumn, told Richard Mullins of Tampa Bay Online, "Are the Coke machine nozzles clean? Is the ice machine maintained? Are the trash cans clean? Because when you drag them through a kitchen, they’re a great way to transport waste and disease. This is something you have to train on every single day, over and over. … My first year here, I think the staff was ready to hang me."

To avoid that fate, the most rigorous restaurant operators get out front of the health department inspections. They contract private companies for extra inspections, with standards much tougher than the government’s.

"The good restaurants know the most important thing is to make the customer happy," said Beth Cannon, associate director of quality assurance for the inspection company Steritech Group Inc.

While some restaurants refrigerate soup in 5-gallon buckets, Brown said that’s far too large a container to cool down enough to prevent bacteria growth. So his chefs seal and date soup in small bags, and soak them in ice water before storage in the refrigerator.

With potentially risky items like oysters, his kitchen keeps records on every one for a year, so any problems can be tracked back to a particular harvester.

Cross-contamination happens in even the smallest instances.

For instance, if a dish-washing employee sprays off plates, loads them in the dishwashing machine and then forgets to wash his hands when unloading the machine, he’ll track potential illnesses to the clean plates.

If a kitchen worker stacks boxes of vegetables on the floor, those boxes will track germs from the floor into the refrigerator.

If a chef prepares patties of raw hamburger, even while wearing gloves, and wipes his hands on his apron, he can track potential bacteria and germs into the "hot" side of the kitchen when grilling burgers.

If a salad chef accidentally touches his nose and then grabs a head of lettuce, he can potentially transfer hepatitis A.
Training a kitchen full of employees on all the right practices isn’t simple, particularly with the high turnover in the restaurant industry.

Five Guys uses Steritech for periodic inspections, but it also employs "mystery eaters" to review each location at least twice a week, grading everything from the bathroom floors to the quality of the fries, said Jo Jo Jiampetti, a regional vice president for Five Guys in Tampa.

"You have to teach every day what the standards are, and hold everyone accountable."

Shock and shame: How to increase handwashing compliance

A British study by the London School of Hygiene and Tropical Medicine concluded that people are more likely to wash their hands properly after using the toilet if they are shamed into it or think they are being watched.

As part of a flood of handwashing information for today’s World Handwashing Day, the study, published in the American Journal of Public Health found that with no reminders, 32 percent of men and 64 percent of women used soap.

The observational study reported on the behavior of people using toilets at motorway service stations in Britain over 32 days.

When prompted by an electronic message flashing up on a board asking: "Is the person next to you washing with soap?," around 12 percent more men and 11 percent more women used soap.

Other messages flashed on the electronic boards included:

• Water doesn’t kill germs, soap does; and,
• Don’t be a dirty soap dodger.

The message that produced the strongest positive response was: "Is the person next to you washing with soap?"

The researchers also noted "intriguing differences" in the behavior of men and women: While women responded to simple reminders, men tended to react best to messages that invoked disgust, such as:

• Don’t take the loo with you — wash with soap, and
• Soap it off or eat it later.

I like the last one.

We’ve undertaken both shock and shame attempts at handwashing messages (below). Results pending.

Telling students to wash their hands isn’t enough: new research identifies barriers to handwashing compliance in a university residence

Food safety researcher and talk-show host Jon Stewart got it right back in 2002 when he said,

“If you think the 10 commandments being posted in a school is going to change behavior of children, then you think “Employees Must Wash Hands” is keeping the piss out of your happy meals. It’s not.”

Instead, getting college students to wash hands, halt disease, requires giving them proper tools and spreading the word in ways that get attention: the path to poor hand sanitation is paved with good intentions, according to researchers from Kansas State and North Carolina State Universities.

As college campuses prepare for an expected increase in H1N1 flu this fall, the researchers said students’ actions will speak louder than words.

"Many students say they routinely wash their hands," said Douglas Powell, an associate professor of food safety at Kansas State University. "But even in an outbreak situation, many students simply don’t."

In February 2006, Powell and two colleagues — Ben Chapman, an assistant professor at North Carolina State University, and research assistant Brae Surgeoner — observed hand sanitation behavior during an outbreak. What was thought to have been norovirus sickened nearly 340 students at the University of Guelph in Canada.

Hand sanitation stations and informational posters were stationed at the entrance to a residence hall cafeteria, where the potential for cross-contamination was high. The researchers observed that even during a high-profile outbreak, students followed recommended hand hygiene procedures just 17 percent of the time. In a self-reported survey after the outbreak had subsided, 83 of 100 students surveyed said they always followed proper hand hygiene but estimated that less than half of their peers did the same.

The results appear in the September issue of the Journal of Environmental Health.

Powell said that in addition to providing the basic tools for hand washing – vigorous running water, soap and paper towels — college students, especially those living in residence halls, need a variety of messages and media continually encouraging them to practice good hand hygiene.

"Telling people to wash their hands or posting signs that say, ‘Wash your hands’ isn’t enough," said Ben Chapman, an assistant professor at North Carolina State University. "Public health officials need to be creative with their communication methods and messages."

Most students surveyed perceived at least one barrier to following recommended hand hygiene procedures. More than 90 percent cited the lack of soap, paper towels or hand sanitizer. Additional perceived barriers were the notion that hand washing causes irritation and dryness, along with just being lazy and forgetful about hand washing. Fewer than 7 percent said a lack of knowledge of the recommended hand hygiene procedures was a barrier.

"Providing more facts is not going to get students to wash their hands," Powell said. "Compelling messages using a variety of media – text messages, Facebook and traditional posters with surprising images — may increase hand washing rates and ultimately lead to fewer sick people."

University students’ hand hygiene practice during a gastrointestinal outbreak in residence: What they say they do and what they actually do
Journal of Environmental Health Sept. issue 72(2): 24-28
Brae V. Surgeoner, MS, Benjamin J. Chapman, PhD, and Douglas A. Powell, PhD
Published research on outbreaks of gastrointestinal illness has focused primarily on the results of epidemiological and clinical data collected postoutbreak; little research has been done on actual preventative practices during an outbreak. In this study, the authors observed student compliance with hand hygiene recommendations at the height of a suspected norovirus outbreak in a university residence in Ontario, Canada. Data on observed practices was compared to post-outbreak self-report surveys administered to students to examine their beliefs and perceptions about hand hygiene. Observed compliance with prescribed hand hygiene recommendations occurred 17.4% of the time. Despite knowledge of hand hygiene protocols and low compliance, 83.0% of students indicated that they practiced correct hand hygiene during the outbreak. To proactively prepare for future outbreaks, a current and thorough crisis communications and management strategy, targeted at a university student audience and supplemented with proper hand washing tools, should be enacted by residence administration.

Lamenting the end of food safety month

Playing the calm, cool Danny Glover to Doug’s crazed Mel Gibson, I wanted to contribute to the food safety month discussion.

I’m not a fan of causes of the month; either an issue is important year-round or it’s not. Food safety month, established sometime in the mid-90s (thanks Google news archives), is supposed to be an awareness-raising time. The goal is to focus consumer food safety communication efforts and coordinate messages.  But does this even work?

Liz Redmond and Chris Griffith published research in 2006 that showed even targeted, specific social media messages (which isn’t really what is seen in the many food safety month press releases) may impact practices right after the audience is exposed to them, but behavior changes were not sustained 4-6 weeks after being exposed:

Results suggested that “one-off” food safety interventions developed and implemented using a social marketing approach may result in a short-term improvement of consumer food safety behaviors.

The unfortunate part about food safety month is that messages get recycled from previous years (sometimes with updated temperatures, sometimes not). It appears that contrary to CDC’s FoodNet report suggestions on enhanced measures, folks are just throwing the same messages year after year. The majority of messages focus on what consumers can do in their home, but few stories exist about what industry, regulators and researchers are doing to address food safety risks. If food safety is a farm-to-fork problem (kind of what HACCP is built on, addressing risks at different points) then our food safety messages need to be farm-to-fork.

Over a decade of food safety months and we’ve got the same annual estimate of foodborne illness incidents. If there’s no measurable impact, why bother?

Let’s get rid of the one-off consumer-focused message blitz that is food safety month.

The best campaign idea I have for food safety month 2009 is a funeral of sorts. The campaign would be focused on lamenting the demise of food safety month and the birth of “Every month is food safety month”.  We can have a New Orleans jazz-type funeral (because they really do them up right with the parade and all) with the cook, chill, clean, separate motto being pulled behind in an elaborate horse-drawn carriage. It will be a somber event for some, but others will rejoice in shedding the tactics that may result in only short-term behavioral changes. New messages and mediums are needed to really affect foodborne illness incidents.

Effective food safety messages for microbial food safety hazards

At some point while endlessly bitching at Chapman to finish his damn thesis and produce some papers, I realized, I wasn’t so good at closing the deal myself.

I could say I like blogging, being quoted in media, the immediacy of it all, but I also realized I needed the credibility of peer-reviewed publications.

So after grappling with divorce, the angst of children lost, the joy of remarriage and once again the commitment to an ideal, another kid, I decided that while I was bitching at Chapman, I better take care of my own shop.

So, with some pride, I announce the first of about a dozen peer-reviewed papers that are going to appear this year.

Designing effective messages for microbial food safety hazards, which will appear in an upcoming issue of Food Control, by Douglas Powell, Casey Jacob and Lisa Mathiasen, was started by Lisa back in 2003. I told her it was going to be published and she said, “about time.”

Casey did some excellent improvements, and the thing is coming out.

Here’s the abstract; I’ll post the full paper info when it’s published.

Despite numerous food safety information campaigns and educational efforts, microbial foodborne illness remains a significant source of human disease. New food safety messages transmitted using new media are required to enhance food safety from farm-to-fork. A review of the literature reveals that targeting a segment of the population and understanding knowledge, attitudes, and perceptions of the individuals comprising that segment can lead to successful communication of food safety messages. Messages found to be effective are relevant to the target audience, contain reliable information, are rapidly distributed at appropriate times, and are repeated. Those containing information that is easily received and understood have also been found effective. The use of media commonly accessed by today’s consumers is also valuable. Evaluation of the effect of all aspects of food safety messages and media, as measured through observation of recipients’ actions, is required to validate the effectiveness of food safety communications.

And I’m in love with my partner, cause she’s the meanest editor I’ve ever had.

And vice-versa.

Save Lives: Clean Your Hands

Megan Hardigree, a research associate at Kansas State University working on hand hygiene, writes that this year, Cinco de Mayo wasn’t just a holiday to celebrate the Mexican army’s victory over the French in the Battle of Puebla (yesterday) or a song by the band, Cake. It was also a day to celebrate the launch of the World Health Organization’s (WHO) newest hand hygiene campaign: Save Lives: Clean Your Hands.

The aim of Save Lives: Clean Your Hands is to stop the spread of infection by increasing hand hygiene of healthcare workers. This is said to be the next step of the original, Clean Care is Safer Care, from 2005. The initiative persuades individuals to join the movement with gain-framed messages (they apparently encourage positive behavior) such as “Help stop hospital acquired infections in your country” and “Make patient safety your number one priority.”

To help support this initiative, WHO has accompanied the promotion with a variety of tools and resources to aid healthcare facilities in promoting and enforcing better hand hygiene. These tools include: tools for system change, tools for training and education, tools for evaluation and feedback, tools as reminders in the workplace, and tools for institutional safety climate. My personal favorite, mostly because of the fun diagram, is in the “tools as reminders in the workplace” which includes “My 5 Moments for Hand Hygiene:”

• before touching a patient;
• before clean/aseptic procedures;
• after body fluid exposure/risk;
• after touching a patient; and,
• after touching patient surroundings.

 “Be a part of a global movement to improve hand hygiene, “ says WHO.

Now to evaluate whether any of these messages actually compel people to wash their hands.